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Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction

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Abstract

For decades, cardiologists have largely underestimated the role of the right heart in heart failure due to left heart disease. Nowadays, the importance of evaluating right ventricular (RV) structure and function in left heart failure is well documented and this concept has been emphasized in the most recent heart failure guidelines. However, several relevant questions remain unanswered such as the following: (a) which imaging technique (standard or 3D echocardiography or strain imaging or cardiac magnetic resonance) and, more, which parameters should be used to grade the severity of RV dysfunction? (b) do less widespread and less applied diagnostic tools such as cardiopulmonary stress testing and bioelectrical impedance analysis play a role in this field? (c) are there specific biochemical aspects of RV failure? (d) why notion of pathophysiology of heart and lung interaction are so well appreciated at an academic level but are not applied in the clinical setting? The present review has been prepared by the Heart Failure (HF) working group of the Italian Society of Cardiology and its main objective is to improve our understanding on RV dysfunction in heart failure.

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Author information

Author notes

  1. Michele Correale and Alberto Palazzuoli equally contributed as co-last authors.

Authors and Affiliations

  1. Divisione Di Cardiologia, IRCCS Fondazione Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy

    Stefano Ghio, Mauro Acquaro, Davide Colombo & Luca Vicini Scajola

  2. Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy

    Mauro Acquaro, Davide Colombo & Luca Vicini Scajola

  3. Centro Cardiologico Monzino, IRCCS, Milan, Italy

    Piergiuseppe Agostoni

  4. Department of Clinical Science and Community Health, University of Milan, Milan, Italy

    Piergiuseppe Agostoni

  5. Cardiology and Cardiovascular Pathophysiology, S.Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy

    Giuseppe Ambrosio, Erberto Carluccio & Francesca Jacoangeli

  6. Interdisciplinary Center for Health Sciences, Scuola Superiore Sant’Anna, Pisa, Italy

    Vincenzo Castiglione & Michele Emdin

  7. Fondazione Toscana G. Monasterio, Pisa, Italy

    Vincenzo Castiglione & Michele Emdin

  8. Department of Cardiology, University L. Vanvitelli - Monaldi Hospital, Naples, Italy

    Michele D’Alto

  9. Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra (Naples), Italy

    Santo Delle Grottaglie

  10. Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA

    Santo Delle Grottaglie

  11. Sant’Agostino Medical Center, Milan, Italy

    Frank Lloyd Dini

  12. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

    Martino Fortunato

  13. Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico of Bari, 70124, Bari, Italy

    Andrea Igoren Guaricci

  14. Department of Translational Medical Sciences, “Federico II” University Hospital and School of Medicine, Naples, Italy

    Alberto M. Marra

  15. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy

    Stefania Paolillo

  16. Mediterranea Cardiocentro, Naples, Italy

    Stefania Paolillo

  17. Department of Clinical, Anesthesiological and Cardiovascular Sciences, I School of Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy

    Sivia Papa

  18. Cardiology Unit, University Hospital Policlinico Riuniti, Foggia, Italy

    Michele Correale

  19. Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital University of Siena, Siena, Italy

    Alberto Palazzuoli

Authors
  1. Stefano Ghio
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  2. Mauro Acquaro
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  3. Piergiuseppe Agostoni
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  4. Giuseppe Ambrosio
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  5. Erberto Carluccio
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  6. Vincenzo Castiglione
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  7. Davide Colombo
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  8. Michele D’Alto
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  9. Santo Delle Grottaglie
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  10. Frank Lloyd Dini
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  11. Michele Emdin
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  12. Martino Fortunato
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  13. Andrea Igoren Guaricci
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  14. Francesca Jacoangeli
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  15. Alberto M. Marra
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  16. Stefania Paolillo
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  17. Sivia Papa
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  18. Luca Vicini Scajola
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  19. Michele Correale
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  20. Alberto Palazzuoli
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Contributions

Stefano Ghio, Dr Palazzuoli, and Dr Correale had the idea, developed the conceptualization of the article, and prepared the final version of the manuscript; all authors performed the literature search and evaluation, prepared a first draft of a specific part of the manuscript, revised the entire manuscript critically for important intellectual content, and finally approved the manuscript submitted.

Corresponding author

Correspondence to Stefano Ghio.

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The authors declare no competing interests.

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Ghio, S., Acquaro, M., Agostoni, P. et al. Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction. Heart Fail Rev 28, 1009–1022 (2023). https://doi.org/10.1007/s10741-022-10276-0

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  • DOI: https://doi.org/10.1007/s10741-022-10276-0

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