Disfunción ventricular derecha: ¿qué opciones tenemos?

For many years, the left ventricle has been the focus of interest and research in cardiovascular medicine, with the right ventricle remaining on the sidelines. However, the recognition that right ventricular dysfunction is the principle prognostic indicator in the majority of cardiovascular diseases has led to increased interest in achieving a more detailed understanding of the physiology and pathophysiology of the right ventricle and its treatment. Right ventricular function can be affected by numerous mechanisms; one main mechanism is the pressure overload that occurs in pulmonary hypertension, whose most frequent cause in our discipline is, in fact, left heart disease. However, regardless of the etiology of pulmonary hypertension, right ventricular function determines prognosis in affected patients. Correspondingly, many of the therapies employed for left heart failure are also used for right ventricular dysfunction, although firm evidence to support this use is lacking. This article summarizes the pathophysiological basis for the development of right heart failure and reviews current evidence on its treatment when managing congestion is paramount. In addition, the role of neurohormonal modulation is considered and, finally, potential therapeutic strategies currently in development are reviewed.

Supplement information: this article is part of a supplement entitled “Questions on a new era for heart failure treatment” which is sponsored by Novartis