From the Guidelines
Atrial right ventricular dysfunction (RVD) can indeed cause decompensated heart failure.
Key Points
- Right-sided heart failure (RHF) is a complex syndrome that includes diverse causes, pathways, and pathological processes, and can lead to decompensated heart failure 1.
- The diverse causes of RHF include primary cardiomyopathies with right ventricular (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.
- Progressive RV dysfunction is associated with increased morbidity and mortality, and can lead to decompensated heart failure 1.
- In the decompensating phase of RHF, there is a concomitant rise in pulmonary vascular resistance (PVR) and right atrial (RA) pressure, leading to a decline in cardiac output (CO) and a reduction in pulmonary artery pressure (PAP) 1.
- The combination of RV systolic and biventricular diastolic dysfunction reduces CO, impairs coronary blood flow, and exacerbates peripheral and abdominal congestion, ultimately leading to decompensated heart failure 1.
- Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output, and progressive end-organ damage, and is the principal cause of death in patients with pulmonary arterial hypertension 1.
From the Research
Atrial Right Ventricular Dysfunction and Decompensated Heart Failure
- Atrial right ventricular dysfunction (RVD) can be a significant predictor of decompensated heart failure, as evidenced by studies 2, 3, 4.
- RVD is often associated with increased risk of atrial fibrillation (AFib), which can further exacerbate heart failure symptoms 2, 5.
- The presence of RVD can lead to worse outcomes in patients with decompensated heart failure, including higher rates of cardiac readmission and mortality 2, 3.
Predictors of RVD in Decompensated Heart Failure
- Older age, history of heart failure, left atrial dilation, and left ventricular hypertrophy are strong predictors of RVD in patients with decompensated heart failure 2.
- Male sex and AFib are also associated with an increased risk of RVD 3.
- Evaluation of right ventricular function using echocardiography can help identify patients at risk of RVD and guide management decisions 3, 6.
Clinical Characteristics of RVD in Decompensated Heart Failure
- Patients with RVD often have more severe clinical symptoms, including higher New York Heart Association (NYHA) functional class and Clinical Condition Scale (CCS) scores 3.
- RVD is associated with lower left ventricular ejection fraction (LVEF) and higher rates of atrial fibrillation 3, 5.
- The presence of RVD can lead to increased concentrations of uric acid and total bilirubin, indicating worse cardiac function 3.