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Early detection of pulmonary arterial hypertension: do not forget the right ventricle

Nature Reviews Cardiology volume 12, page 134 (2015)Cite this article

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We read with great interest the Review by Lau et al. (Early detection of pulmonary arterial hypertension. Nat. Rev. Cardiol. doi:10.1038/nrcardio.2014.191), and we agree with the authors about the importance of early diagnosis of pulmonary arterial hypertension (PAH) to improve survival, particularly in young patients.1 We would like to focus more attention on right ventricular (RV) adaptation and its relationship to outcomes during PAH.

Increased pulmonary pressure can occur independently of increases in pulmonary wedge pressure and pulmonary vascular resistance. In the latter instance, increased pulmonary arterial pressure strictly depends on pulmonary vascular properties.2 In both cases, the increased afterload leads to several RV adaptations; this phenomenon depends not only on the severity of pulmonary vascular disease, but is also related to neurohormonal activation, myocardial perfusion, and cardiomyocyte metabolism.2,3 On the basis of RV volume dilatation or free wall thickness, we currently recognize two distinct RV patterns. Firstly, an adaptive pattern consisting of concentric remodelling (high ratio of mass to volume), increased myocardial wall thickness, preserved systolic function, and increased filling pressure. Secondly, a maladaptive pattern consisting of eccentric hypertrophy (low ratio of mass to volume), an increase in RV free wall, and concomitant systolic dysfunction.3,4

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References

  1. Lau, E. M. T., Humbert, M. & Celermajer, D. S. Early detection of pulmonary arterial hypertension. Nat. Rev. Cardiol. http://dx.doi.org/10.1038/nrcardio.2014.191.

  2. Voelkel, N. F. et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure. Circulation 114, 1883–1891 (2006).

    Article  Google Scholar 

  3. Vonk-Noordegraaf, A. et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J. Am. Coll. Cardiol. 62 (Suppl.), D22–D33 (2013).

    Article  Google Scholar 

  4. Champion, H. C., Michelakis, E. D. & Hassoun, P. M. Comprehensive invasive and noninvasive approach to the right ventricle–pulmonary circulation unit: state of the art and clinical and research implications. Circulation 120, 992–1007 (2009).

    Article  Google Scholar 

  5. Rudski, L. G. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J. Am. Soc. Echocardiogr. 23, 685–713 (2010).

    Article  Google Scholar 

  6. Bossone, E., Bodini, B. D., Mazza, A. & Allegra, L. Pulmonary arterial hypertension: the key role of echocardiography. Chest 127, 1836–1843 (2005).

    Article  Google Scholar 

  7. Forfia, P. R. et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am. J. Respir. Crit. Care Med. 174, 1034–1041 (2006).

    Article  Google Scholar 

  8. McLure, L. E. & Peacock, A. J. Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension. Eur. Respir. J. 33, 1454–1466 (2009).

    Article  CAS  Google Scholar 

  9. Vonk-Noordegraaf, A. & Souza, R. Cardiac magnetic resonance imaging: what can it add to our knowledge of the right ventricle in pulmonary arterial hypertension? Am. J. Cardiol. 110 (Suppl.), 25S–31S (2012).

    Article  Google Scholar 

  10. Van Wolferen, S. A. et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur. Heart J. 28, 1250–1257 (2007).

    Article  Google Scholar 

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  1. Department of Internal and Surgical Medicine, Cardiovascular Diseases Unit, University of Siena, Viale Bracci 16, Siena, 53100, Italy

    Gaetano Ruocco & Alberto Palazzuoli

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  1. Gaetano Ruocco
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  2. Alberto Palazzuoli
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Correspondence to Gaetano Ruocco.

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Ruocco, G., Palazzuoli, A. Early detection of pulmonary arterial hypertension: do not forget the right ventricle. Nat Rev Cardiol 12, 134 (2015). https://doi.org/10.1038/nrcardio.2014.191-c1

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