Right ventricle failure in patients treated with left ventricular assist device

TOWARDS A UNIVERSAL DEFINITION FOR RIGHT HEART FAILURE:A WORK IN PROGRESS

BACKGROUND

Broadly speaking, right heart failure can be defined as a clinical syndrome with signs and symptoms of heart failure resulting from right ventricular dysfunction, as evidenced by abnormal structure or function. The heterogeneity of conditions associated with right heart failure combined with the challenges of characterizing the structural and functional relationships of the right ventricle make a singular definition of right heart failure elusive. We performed a concise scoping review of the literature that provides knowledge synthesis of right heart failure in different clinical populations, and extracted the recommended criteria to define the syndrome.

METHODS

Searches were conducted to identify reviews, guidelines, consensus statements, systematic reviews, meta-analysis and consensus statements concerning right heart or right ventricular failure in well described adult human disease populations from the previous 10 years. After removal of case reports and duplicates, publications describing syndromes in the context of left sided heart disease were also removed. Data extracted from selected manuscripts included the patient population and quantitative criteria to define right heart failure, categorized based on diagnostic modalities.

RESULTS

Of 9487 articles initially identified, 71 were selected for full text review. We found that the majority of the reviewed literature offered multi-faceted diagnostic approaches, including clinical, echocardiographic, hemodynamic and therapeutic characteristics, with unique additions or omissions depending on the clinical contexts. Nomenclature for right heart failure was variable and only 40% of articles articulated a narrative definition.

CONCLUSION

At this time, development of consistent criteria and a universal definition for right heart failure remains a work in process.