TY - JOUR
T1 - Right heart failure in pulmonary hypertension
T2 - Diagnosis and new perspectives on vascular and direct right ventricular treatment
AU - Tello, Khodr
AU - Seeger, Werner
AU - Naeije, Robert
AU - Vanderpool, Rebecca
AU - Ghofrani, Hossein Ardeschir
AU - Richter, Manuel
AU - Tedford, Ryan J
AU - Bogaard, Harm J
N1 - Funding Information: Editorial assistance was provided by Dr Claire Mulligan (Beacon Medical Communications Ltd., Brighton, UK), funded by the University of Giessen. The study was funded by Deutsche Forschungsgesellschaft, Project CRC 1213 B08. Funding Information: Editorial assistance was provided by Dr Claire Mulligan (Beacon Medical Communications Ltd., Brighton, UK), funded by the University of Giessen. The study was funded by Deutsche Forschungsgesellschaft, Project CRC 1213 B08. Funding Information: K.T. has received speaking fees from Actelion and Bayer. W.S. has received speaker/consultancy fees from Pfizer, Bayer Pharma AG, United Therapeutics, and Liquidia. R.N. has relationships with drug companies including AOPOrphan Pharmaceuticals, Actelion, Bayer, Reata, Lung Biotechnology Corporation, and United Therapeutics. In addition to being an investigator in trials involving these companies, relationships include consultancy service, research grants, and membership of scientific advisory boards. R.V. has nothing to disclose. H.A.G. has received consultancy fees from Bayer, Actelion, Pfizer, Merck, GSK, and Novartis; fees for participation in advisory boards from Bayer, Pfizer, GSK, Actelion, and Takeda; lecture fees from Bayer HealthCare, GSK, Actelion, and Encysive/Pfizer; industry‐sponsored grants from Bayer HealthCare, Aires, Encysive/Pfizer, and Novartis; and sponsored grants from the German Research Foundation, Excellence Cluster Cardiopulmonary Research, and the German Ministry for Education and Research. M.R. has received support from United Therapeutics and Bayer; speaker fees from Actelion, Mundipharma, Roche, and OMT; and consultancy fees from Bayer. R.J.T. is a consultant for Actelion, Merck, Arena Pharmaceuticals, and United Therapeutics Research and a member of an advisory board for Abiomed. H.J.B. has received financial support from Actelion, GSK, and Therabel and grant support from the Dutch Cardiovascular Alliance. Publisher Copyright: © 2019 The British Pharmacological Society Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Adaptation of right ventricular (RV) function to increased afterload—known as RV–arterial coupling—is a key determinant of prognosis in pulmonary hypertension. However, measurement of RV–arterial coupling is a complex, invasive process involving analysis of the RV pressure–volume relationship during preload reduction over multiple cardiac cycles. Simplified methods have therefore been proposed, including echocardiographic and cardiac MRI approaches. This review describes the available methods for assessment of RV function and RV–arterial coupling and the effects of pharmacotherapy on these variables. Overall, pharmacotherapies for pulmonary hypertension have shown beneficial effects on various measures of RV function, but it is often unclear if these are direct RV effects or indirect results of afterload reduction. Studies of the effects of pharmacotherapies on RV–arterial coupling are limited and mostly restricted to experimental models. Simplified methods to assess RV–arterial coupling should be validated and incorporated into routine clinical follow-up and future clinical trials. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
AB - Adaptation of right ventricular (RV) function to increased afterload—known as RV–arterial coupling—is a key determinant of prognosis in pulmonary hypertension. However, measurement of RV–arterial coupling is a complex, invasive process involving analysis of the RV pressure–volume relationship during preload reduction over multiple cardiac cycles. Simplified methods have therefore been proposed, including echocardiographic and cardiac MRI approaches. This review describes the available methods for assessment of RV function and RV–arterial coupling and the effects of pharmacotherapy on these variables. Overall, pharmacotherapies for pulmonary hypertension have shown beneficial effects on various measures of RV function, but it is often unclear if these are direct RV effects or indirect results of afterload reduction. Studies of the effects of pharmacotherapies on RV–arterial coupling are limited and mostly restricted to experimental models. Simplified methods to assess RV–arterial coupling should be validated and incorporated into routine clinical follow-up and future clinical trials. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
UR - http://www.scopus.com/inward/record.url?scp=85075953879&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bph.14866
DO - https://doi.org/10.1111/bph.14866
M3 - Review article
C2 - 31517994
SN - 0007-1188
VL - 178
SP - 90
EP - 107
JO - British journal of pharmacology
JF - British journal of pharmacology
IS - 1
ER -