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Review
. 2020 May;38(2):149-160.
doi: 10.1016/j.ccl.2020.01.009. Epub 2020 Mar 5.

Pathophysiology of Acute and Chronic Right Heart Failure

Rajarajan A Thandavarayan  1 , Kalyan R Chitturi  1 , Ashrith Guha  2
Affiliations
Review

Pathophysiology of Acute and Chronic Right Heart Failure

Rajarajan A Thandavarayan et al. Cardiol Clin. 2020 May.

Abstract

Right-sided heart failure (RHF) occurs from impaired contractility of the right ventricle caused by pressure, volume overload, or intrinsic myocardial contractile dysfunction. The development of subclinical right ventricle (RV) dysfunction or overt RHF is a negative prognostic indicator. Recent attention has focused on RV-specific inflammatory growth factors and mediators of myocardial fibrosis to elucidate the mechanisms leading to RHF and potentially guide the development of novel therapeutics. This article focuses on the distinct changes in RV structure, mechanics, and function, as well as molecular and inflammatory mediators involved in the pathophysiology of acute and chronic RHF.

Keywords: Angiogenesis; Hypertrophy; Inflammation; Mechanical circulatory support; Metabolism; Pulmonary hypertension; Right heart failure.

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Conflict of interest statement

Disclosure The authors have no commercial or financial conflicts of interest or disclosures.

Figures

Figure 1:
Figure 1:. Acute Right Heart Failure: Pathophysiology, Etiologies, Metabolic, and Inflammatory Pathways
(mIR)-126 = microRNA expressed on endothelial cells involved angiogenesis transcriptional processes (mIR)-208 = microRNA involved in regulation of beta-myosin heavy chain production in development, stress-dependent growth factor CCL = C-C chemokine ligand CCR1 = C-C chemokine receptor type 1 CXCL = C-X-C chemokine ligand involved in neutrophil activation CXCR4 = C-X-C chemokine receptor type 4 involved in lymphocyte chemotaxis ERK1/2 = phosphorylated extracellular regulated kinase IL-1β = interleukin-1β IL-6 = interleukin-6 LVAD = left ventricular assist device PDK = pyruvate dehydrogenase kinase ROS = reactive oxygen species RVMI = right ventricular myocardial infarction TGF-β = transforming growth factor-β TNF-α = tumor necrosis factor-a Wnt pathway = Single transduction pathway involved in activation of mitochondrial biogenesis, leading to production of ROS
Figure 2:
Figure 2:. Chronic pressure overload induced Right Heart Failure: Molecular and cellular mechanisms
RV: right ventricle, LV: left ventricle, ROS: reactive oxygen species.
See this image and copyright information in PMC

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