The right ventricle in abnormal loading conditions
The right ventricle in abnormal loading conditions
The right ventricle (RV) differs fundamentally from the left ventricle (LV) in structure and function. Once viewed as a passive pump, the RV is now recognized as crucial in heart failure (HF), pulmonary hypertension, and congenital heart defects such as transposition of the great arteries (TGA).
This thesis of Sina Ansari Ramandi investigates RV dysfunction in two contexts: (1) left-sided HF, where the RV serves a subpulmonic role, and (2) TGA, where the systemic RV (sRV) sustains systemic pressures. In newly diagnosed HF, RV dysfunction was prevalent (38.6%) and predicted adverse outcomes; improvement following optimized medical therapy, particularly with ACE inhibitors or ARBs, correlated with better prognosis. A systematic review in TGA patients with sRV demonstrated elevated mortality and HF hospitalization rates, predicted by impaired RV/LV function and elevated NT-proBNP. In a multicenter cohort, 25% of sRV patients experienced HF-related admissions; a novel risk score effectively identified high-risk individuals. Bioactive adrenomedullin (bio-ADM) was associated with congestion and HF events.
sRV patients reported reduced quality of life (QoL), influenced by ventricular dysfunction and psychosocial determinants. A case study illustrated the technical feasibility of ventricular assist device implantation in end-stage sRV failure.
These findings emphasize the need for regular RV/LV assessment, personalized risk stratification, biomarker integration, and targeted psychosocial support. Future research should focus on identifying high-risk groups for tailored interventions, examining ethnic and geographic QoL disparities, and conducting longitudinal studies to assess therapy effects on both cardiac and psychosocial outcomes.