From the Guidelines
Isolated right ventricular (RV) failure is primarily caused by pulmonary hypertension, right ventricular infarction, pulmonary embolism, congenital heart defects, and other conditions that increase RV afterload, decrease RV contractility, or increase preload. The causes of isolated RV failure can be diverse, including primary cardiomyopathies with RV involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease 1.
Some of the key causes of isolated RV failure include:
- Pulmonary hypertension (both pulmonary arterial hypertension and pulmonary hypertension due to left heart disease, lung disease, or chronic thromboembolic disease)
- Right ventricular infarction (typically from occlusion of the right coronary artery)
- Pulmonary embolism (acute or chronic)
- Congenital heart defects (such as Ebstein's anomaly or tetralogy of Fallot)
- Arrhythmogenic right ventricular cardiomyopathy
- Right ventricular myocarditis
- Tricuspid valve disease
- Pericardial disease restricting right ventricular filling
- High-output states like severe anemia or hyperthyroidism
According to the most recent guidelines, management of isolated RV failure depends on identifying and treating the underlying cause while supporting RV function through optimization of preload, afterload reduction, and inotropic support when necessary 1. For example, in patients with pulmonary hypertension, type V phosphodiesterase inhibitors, endothelin antagonists, and prostacyclin analogues may help by decreasing pulmonary arterial resistance 1. Additionally, pulmonary valve replacement can improve symptoms and RV function in patients with pulmonary regurgitation after intervention for pulmonary stenosis 1.
It is essential to note that the pathophysiology of isolated RV failure involves increased RV afterload, decreased RV contractility, or increased preload that exceeds the RV's capacity, leading to RV dilation and impaired left ventricular filling, which can further compromise cardiac output 1. Therefore, early identification and treatment of the underlying cause are crucial to prevent progressive RV dysfunction and improve patient outcomes.
From the Research
Causes of Isolated Right Ventricular (RV) Failure
The causes of isolated right ventricular (RV) failure can be diverse and complex. Some of the key causes include:
- Pulmonary hypertension, which can lead to increased afterload on the right ventricle, resulting in failure 2, 3, 4
- Cardiomyopathy, which can affect the right ventricle and lead to failure 3
- Myocardial infarction, particularly right ventricular myocardial infarction, which can cause acute RV failure 5
- Congenital or valvular heart disease, which can increase the workload on the right ventricle and lead to failure 3
- Sepsis, which can cause acute RV failure due to increased pulmonary vascular resistance and decreased RV contractility 6
- Acute lung injury, which can increase pulmonary vascular resistance and lead to RV failure 6
- Cardiothoracic surgery, which can cause acute RV failure due to various factors such as ischemia, reperfusion injury, and increased pulmonary vascular resistance 6
Underlying Mechanisms
The underlying mechanisms of isolated RV failure can involve inflammation, which plays a crucial role in the pathogenesis of RV failure 4. Inflammatory biomarkers and immune mediators can contribute to the deterioration of RV function and impact RV function adaptation to increased afterload.
Clinical Implications
Understanding the causes and underlying mechanisms of isolated RV failure is essential for developing effective treatment strategies. Treatment options may include pharmacological therapy, mechanical RV support, and heart transplantation, and should be directed at the underlying cause of RV failure 3, 6.