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Kuroda T, Miyagi C, Fukamachi K, Karimov JH. Mechanical circulatory support devices and treatment strategies for right heart failure. Front Cardiovasc Med 2022; 9:951234. [PMID: 36211548 PMCID: PMC9538150 DOI: 10.3389/fcvm.2022.951234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
The importance of right heart failure (RHF) treatment is magnified over the years due to the increased risk of mortality. Additionally, the multifactorial origin and pathophysiological mechanisms of RHF render this clinical condition and the choices for appropriate therapeutic target strategies remain to be complex. The recent change in the United Network for Organ Sharing (UNOS) allocation criteria of heart transplant may have impacted for the number of left ventricular assist devices (LVADs), but LVADs still have been widely used to treat advanced heart failure, and 4.1 to 7.4% of LVAD patients require a right ventricular assist device (RVAD). In addition, patients admitted with primary left ventricular failure often need right ventricular support. Thus, there is unmet need for temporary or long-term support RVAD implantation exists. In RHF treatment with mechanical circulatory support (MCS) devices, the timing of the intervention and prediction of duration of the support play a major role in successful treatment and outcomes. In this review, we attempt to describe the prevalence and pathophysiological mechanisms of RHF origin, and provide an overview of existing treatment options, strategy and device choices for MCS treatment for RHF.
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Affiliation(s)
- Taiyo Kuroda
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Jamshid H. Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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Cameli M, Pastore MC, Henein MY, Mondillo S. The left atrium and the right ventricle: two supporting chambers to the failing left ventricle. Heart Fail Rev 2020; 24:661-669. [PMID: 31025236 DOI: 10.1007/s10741-019-09791-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) is mainly caused by left ventricular (LV) impairment of function, hence detailed assessment of its structure and function is a clinical priority. The frequent involvement of the left atrium (LA) and the right ventricle (RV) in the overall cardiac performance has recently gained significant interest with specific markers predicting exercise intolerance and prognosis being proposed. The LA and RV are not anatomically separated from the LV, while the LA controls the inlet the RV shares the interventricular septum with the LV. Likewise, the function of the two chambers is not entirely independent from that of the LV, with the LA enlarging to accommodate any rise in filling pressures, which could get transferred to the RV via the pulmonary circulation. In the absence of pulmonary disease, LA and RV function may become impaired in patients with moderate-severe LV disease and raised filling pressures. These changes can often occur irrespective of the severity of systolic dysfunction, thus highlighting the important need for critical assessment of the function of the two chambers. This review evaluates the pivotal role of the left atrium and right ventricle in the management of HF patients based on the available evidence.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Liao H, Chen Q, Liu L, Zhong S, Deng H, Xiao C. Impact of concurrent right ventricular myocardial infarction on outcomes among patients with left ventricular myocardial infarction. Sci Rep 2020; 10:1736. [PMID: 32015449 PMCID: PMC6997358 DOI: 10.1038/s41598-020-58713-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023] Open
Abstract
To compare in-hospital outcomes between left ventricular myocardial infarction (LVMI) patients with and without right ventricular myocardial infarction (RVMI). Patients with acute ST-segment elevation MI (STEMI) undergoing primary percutaneous coronary intervention (PCI) were enrolled and divided into LVMI with and without RVMI groups. Between-group differences and in-hospital outcomes were compared. Compared to patients without RVMI, patients with RVMI were more likely to be male, have higher body mass index, serum levels of C-reactive protein (8.9 ± 2.4 vs 6.2 ± 2.1 mg/dL), B-type natriuretic peptide (1295 ± 340 vs 872 ± 166 pg/mL) and cardiac troponin-I (8.6 ± 2.9 vs 5.2 ± 2.1 ng/mL), and have diabetes (36.3% vs 3.4%) and dyslipidemia (53.4% vs 48.1%). Patients with RVMI had lower left and right ventricular ejection fraction (50.5 ± 5.6% vs 53.4 ± 3.8% and 33.6 ± 2.9% vs 45.7 ± 2.0%), but had higher mean pulmonary artery pressure (30.6 ± 3.3 vs 23.8 ± 3.1 mm Hg). Compared to patients without RVMI, patients with RVMI had higher odds of in-hospital all-cause mortality (4.1% vs 1.0%) and new onset acute heart failure (3.4% vs 1.0%). After adjusted for confounding factors, LVMI with RVMI remained independently associated with composite outcomes, with odds ratio 1.66 (95% confidence interval 1.39–2.04). Compared to isolated LVMI patients, those with concomitant RVMI have higher odds of in-hospital complications, particularly all-cause mortality and new onset acute heart failure.
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Affiliation(s)
- Huocheng Liao
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China
| | - Qiuyue Chen
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China
| | - Lin Liu
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China
| | - Sigan Zhong
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China
| | - Huazhao Deng
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China
| | - Chun Xiao
- The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou, Guangdong, China.
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Frenette AJ, Veillette C, Meade M, Poulin F, D'Aragon F, Albert M, Marsolais P, Williamson D, Charbonney E, Serri K. Right ventricular dysfunction in neurologically deceased organ donors: An observational study in a tertiary-care organ donor referral centre. J Crit Care 2019; 54:37-41. [DOI: 10.1016/j.jcrc.2019.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 07/12/2019] [Indexed: 12/21/2022]
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Stickel S, Gin-Sing W, Wagenaar M, Gibbs JSR. The practical management of fluid retention in adults with right heart failure due to pulmonary arterial hypertension. Eur Heart J Suppl 2019; 21:K46-K53. [PMID: 31857800 PMCID: PMC6915055 DOI: 10.1093/eurheartj/suz207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Our aim with this review is to provide practical advice and management support for nurses and other healthcare practitioners in managing fluid retention in adults with right heart failure (RHF) due to pulmonary arterial hypertension (PAH). Vigilant management of RHF is important for maintaining patient quality of life, as fluid overload can lead to abdominal bloating (ascites) and peripheral oedema, which also has a major impact on patients' morbidity and mortality. Patients with RHF should be assessed regularly for signs of fluid retention. If fluid overload develops, it is important to determine whether it is caused by the progression of PAH, a side effect of PAH-specific treatment, or another drug or comorbid condition, as this affects both the prognosis and the management strategy. Right heart failure can be treated with both pharmacological and non-pharmacological interventions to reduce fluid retention; including altering fluid and salt intake, weight monitoring, and use of diuretics. All patients on diuretics should be regularly monitored for renal dysfunction and electrolyte imbalance and given advice on how to manage the side effects associated with diuretic use. Fluid retention is often assessed and treated in clinical practice by specialist nurses, who act as a key patient contact providing advice and information on symptom management. This review provides an overview of the challenges related to fluid retention, including strategies to help patients manage symptoms and side effects of treatment.
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Affiliation(s)
- Simone Stickel
- University Hospital of Zurich, Department of Pneumonology, C HOER 4, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Wendy Gin-Sing
- National Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, UK
| | - Martha Wagenaar
- Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - J Simon R Gibbs
- National Heart & Lung Institute, Imperial College London, Cale Street, London, SW3 6LY, UK
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Pulmonary Arterial Hypertension Emergency Complications and Evaluation: Practical Guide for the Advanced Practice Registered Nurses in the Emergency Department. Adv Emerg Nurs J 2019; 40:246-259. [PMID: 30365438 PMCID: PMC6221388 DOI: 10.1097/tme.0000000000000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary hypertension (PH) complicates common diseases and can lead to worsening symptoms and increased mortality. A specific group of PH, pulmonary arterial hypertension (PAH), World Health Organization Group 1, may present to the emergency department (ED). We review common ED presentations of patients with PAH such as cardiac arrest/sudden death, right ventricular failure, syncope, hypoxemic respiratory failure, arrhythmias, hemoptysis, pulmonary embolism, chest pain/left main compression syndrome, infection, and considerations for PAH medication administration. We include a case study to illustrate a real example with a positive outcome, and an algorithm for evaluating and triaging patients with PAH in the ED. The ability to recognize, triage, and communicate changes in PAH disease status in a multidisciplinary team approach between the patient, family, specialty pharmacy, and specialized health care providers such as the PH team, is essential for ED providers who are evaluating and treating patients with PAH.
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Suh YJ, Kim D, Shim CY, Han K, Chang BC, Lee S, Hong GR, Choi BW, Kim YJ. Tricuspid annular diameter and right ventricular volume on preoperative cardiac CT can predict postoperative right ventricular dysfunction in patients who undergo tricuspid valve surgery. Int J Cardiol 2019; 288:44-50. [PMID: 30890274 DOI: 10.1016/j.ijcard.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/02/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND We investigated the predictive value of preoperative computed tomography (CT)-derived tricuspid annular and right ventricular (RV) parameters for postoperative RV dysfunction in patients undergoing tricuspid valve (TV) surgery. METHODS We retrospectively reviewed clinical, transthoracic echocardiography (TTE), and CT data of 100 consecutive patients who underwent cardiac CT and subsequently received TV surgery. Preoperative cardiac CT and TTE parameters were analyzed, including TV annulus diameter and RV size. Univariate and multivariate logistic regression analyses were performed to identify significant predictors for postoperative RV dysfunction, both in the entire study population and in the subgroup of patients without preoperative RV dysfunction. RESULTS Postoperative RV dysfunction occurred in 46% of all patients. In the multivariate logistic regression analysis, longer TV annulus diameter (>29.3 mm/m2 on four-chamber view; (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.13-11.24), larger RV volume (RV end-diastolic volume/body surface area > 128.8 ml/m2) on CT (OR 3.85, 95% CI 1.24-11.98) and presence of preoperative RV dysfunction on TTE (OR 11.96, 95% CI 2.8-50.99) were independent predictors for postoperative RV dysfunction in the entire study population (P < 0.05). Among patients without preoperative RV dysfunction, longer TV annulus diameter (OR 4.02, 95% CI 1.20-13.41) and larger RV volume on CT (OR 6.09, 95% CI 1.87-19.80) were independent predictors for postoperative RV dysfunction (P < 0.05). CONCLUSIONS Preoperative assessment of cardiac CT imaging-based TV annular diameter and RV volume can provide independent information for predicting postoperative RV dysfunction in patients undergoing TV surgery.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Darae Kim
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Chi Young Shim
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Byung-Chul Chang
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea; Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Republic of Korea
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Geu-Ru Hong
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Republic of Korea.
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Utility of Novel Cardiorenal Biomarkers in the Prediction and Early Detection of Congestive Kidney Injury Following Cardiac Surgery. J Clin Med 2018; 7:jcm7120540. [PMID: 30545066 PMCID: PMC6306702 DOI: 10.3390/jcm7120540] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
Acute Kidney Injury (AKI) in the context of right ventricular failure (RVF) is thought to be largely congestive in nature. This study assessed the utility of biomarkers high sensitivity cardiac troponin T (hs-cTnT), N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), and neutrophil gelatinase-associated lipocalin (NGAL) for prediction and early detection of congestive AKI (c-AKI) following cardiac surgery. This prospective nested case-control study recruited 350 consecutive patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. Cases were patients who developed (1) AKI (2) new or worsening RVF, or (3) c-AKI. Controls were patients free of these complications. Biomarker levels were measured at baseline after anesthesia induction and immediately postoperatively. Patients with c-AKI had increased mean duration of mechanical ventilation and length of stay in hospital and in the intensive care unit (p < 0.01). For prediction of c-AKI, baseline NT-proBNP yielded an area under the curve (AUC) of 0.74 (95% CI, 0.60–0.89). For early detection of c-AKI, postoperative NT-proBNP yielded an AUC of 0.78 (0.66–0.91), postoperative hs-cTnT yielded an AUC of 0.75 (0.58–0.92), and ∆hs-cTnT yielded an AUC of 0.80 (0.64–0.96). The addition of baseline creatinine to ∆hs-cTnT improved the AUC to 0.87 (0.76–0.99), and addition of diabetes improved the AUC to 0.93 (0.88–0.99). Δhs-cTnT alone, or in combination with baseline creatinine or diabetes, detects c-AKI with high accuracy following cardiac surgery.
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Santiago-Vacas E, Farrero M, Ivey-Miranda JB, Castel MÁ, García-Álvarez A, Rios J, Perez-Villa F. Initial experience with bosentan for the management of pulmonary hypertension after heart transplantation. Clin Transplant 2018; 32:e13364. [PMID: 30058129 DOI: 10.1111/ctr.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) after heart transplantation (HT) is associated to right ventricular (RV) dysfunction and increased morbidity and mortality. We present our experience with bosentan for the treatment of PH after HT. METHODS A retrospective evaluation of patients with PH receiving bosentan post-transplant was performed. Pulmonary hemodynamics before and after bosentan (BG) and clinical outcomes were assessed and compared to a historical control group (CG) not receiving bosentan. RESULTS Between 2013 and 2016, 21 patients were treated post-transplant with bosentan. Twenty-four hours after bosentan initiation, there were significant decreases in systolic (42.5 ± 8 to 38.1 ± 8 mm Hg, P = 0.015), diastolic (21.4 ± 4 to 17.8 ± 6 mm Hg, P = 0.008) and mean (29.6 ± 5 to 25 ± 6 mm Hg, P = 0.001) pulmonary artery pressures (PAP), transpulmonary gradient (13.1 ± 3 to 9.7 ± 4 mm Hg, P < 0.001), diastolic gradient (5.2 ± 4 to 2.3 ± 3 mm Hg, P = 0.001) and pulmonary vascular resistance (PVR) (2.2 ± 1 to 1.6 ± 1WU, P = 0.015). This effect was maintained at day 3. Compared with CG, BG showed significantly more decrease in PVR (0.7 ± 0.9 vs 0.3 ± 1.7WU, P = 0.025) and mean PAP (4.6 ± 5.2 vs 1.5 ± 4.4 mm Hg, P = 0.040). RV function 7 days post-transplant was significantly better in BG compared to CG, P = 0.004. There were not clinically significant interactions between bosentan and immunosuppressive treatment. CONCLUSIONS Bosentan, initiated early post-transplant, was associated with a significant decrease in PVR. Bosentan was well tolerated and did not interact with immunosuppressive treatment.
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Affiliation(s)
- Evelyn Santiago-Vacas
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Marta Farrero
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Juan B Ivey-Miranda
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Maria Ángeles Castel
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Ana García-Álvarez
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - José Rios
- Medical Statistics Core Facility, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Perez-Villa
- Heart Failure and Heart Transplantation Unit, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
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Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e578-e622. [DOI: 10.1161/cir.0000000000000560] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose:
The diverse causes of right-sided heart failure (RHF) include, among others, 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. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
Methods:
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
Results:
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
Conclusions:
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
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Bonou M, Kapelios CJ, Kaltsas G, Perreas K, Toutouzas K, Barbetseas J. Cardiac Surgery for Carcinoid Heart Disease: A Weapon Not to Be Misused. Cardiology 2016; 136:243-251. [PMID: 27832643 DOI: 10.1159/000450938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022]
Abstract
Carcinoid heart disease (CHD) complicates approximately 25% of patients with a carcinoid tumor and carcinoid syndrome and leads to heart valve degeneration with mixed-stenotic and regurgitation pathology and consequent heart failure (HF) leading to significant morbidity and mortality. Cardiac surgery in symptomatic, severe CHD leads to significantly better functional capacity and prolonged survival when compared to medical treatment alone. Recent studies have shown improvement in postoperative outcomes of patients undergoing surgery for CHD over the last decades. The trend for early diagnosis and application of surgery prior to the manifestation of HF symptoms, which tended to develop during the previous years, does not seem justifiable based on the findings of recent studies. Therefore, the optimal timing of intervention in CHD and the type of valve that should preferably be used remain issues of controversy. This review comprehensively examines the existing literature on the treatment options for patients with CHD, with a special focus on short- and long-term survival after cardiac surgery, and discusses the selection of the exact patient profile and intervention timing that are more likely to optimize the benefit-to-risk ratio for surgical intervention.
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Affiliation(s)
- Maria Bonou
- Department of Cardiology, Laiko General Hospital, Athens, Greece
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12
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Guerrero Orriach JL, Galán Ortega M, Ramírez Fernandez A, Ariza Villanueva D, Florez Vela A, Moreno Cortés I, Rubio Navarro M, Cruz Mañas J. Assessing the effect of preoperative levosimendan on renal function in patients with right ventricular dysfunction. J Clin Monit Comput 2016; 31:227-230. [PMID: 26762127 DOI: 10.1007/s10877-016-9827-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
The Acute Kidney Injury Network (AKIN) classification considers SCr values, urea and urine output in order to improve timely diagnose ARF and improve patient prognosis by early treatment. Preoperative levosimendan is a new way for cardiac and kidney protection, we try to evaluate this drug in fifteen patients comparing values of AKIN scale parameters pre and post cardiac surgery in patients with right ventricle dysfunction.
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Affiliation(s)
- Jose L Guerrero Orriach
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain.
| | - M Galán Ortega
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - A Ramírez Fernandez
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - D Ariza Villanueva
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - A Florez Vela
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - I Moreno Cortés
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - M Rubio Navarro
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
| | - J Cruz Mañas
- Department of Anaesthesia, Hospital Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
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Poels EM, da Costa Martins PA, van Empel VPM. Adaptive capacity of the right ventricle: why does it fail? Am J Physiol Heart Circ Physiol 2015; 308:H803-13. [DOI: 10.1152/ajpheart.00573.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
Only in recent years has the right ventricle (RV) function become appreciated to be equally important to the left ventricle (LV) function to maintain cardiac output. Right ventricular failure is, irrespectively of the etiology, associated with impaired exercise tolerance and poor survival. Since the anatomy and physiology of the RV is distinctly different than that of the LV, its adaptive mechanisms and the pathways involved are different as well. RV hypertrophy is an important mechanism of the RV to preserve cardiac output. This review summarizes the current knowledge on the right ventricle and its response to pathologic situations. We will focus on the adaptive capacity of the right ventricle and the molecular pathways involved, and we will discuss potential therapeutic interventions.
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Affiliation(s)
- Ella M. Poels
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paula A. da Costa Martins
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; and
| | - Vanessa P. M. van Empel
- Department of Cardiology, Heart Vessel Center, Maastricht University Medical Centre, Maastricht, The Netherlands
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Albert DC, del Cerro MJ, Ignacio Carrasco J, Portela F. [Update on pediatric cardiology and congenital heart disease: imaging techniques, pulmonary arterial hypertension, hybrid treatment, and surgical treatment]. Rev Esp Cardiol 2014; 64 Suppl 1:59-65. [PMID: 21276491 DOI: 10.1016/s0300-8932(11)70008-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article contains a review of the most significant contributions to pediatric cardiology and congenital heart disease reported in publications between September 2009 and August 2010. The review focuses on imaging techniques, new treatment for pulmonary arterial hypertension in pediatric patients, and therapy in general (e.g. hybrid treatment and surgical treatment). With regard to imaging techniques, the review highlights the increasing application of congenital heart disease diagnosis during fetal life, the introduction of new echocardiographic techniques (e.g. tissue Doppler imaging, two-dimensional speckle-tracking imaging and three-dimensional echocardiography) into routine clinical practice, and the growing use of cardiac CT and magnetic resonance imaging in diagnosis and the assessment of cardiac function, respectively. The role played by cardiac interventions continues to increase and cardiac surgery is becoming more advanced and has, in some cases, been combined with hybrid techniques. However, there are still a number of controversial issues in cardiac surgery that have not yet been resolved, such as whether or not fenestration should be used with Fontan surgery, the optimum type of correction for hypoplastic left heart syndrome, and the best conduit for pulmonary artery replacement.
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Affiliation(s)
- Dimpna C Albert
- Àrea del Cor, Hospital Materno-Infantil Vall d'Hebron, Barcelona, España
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Oral Anticoagulation for Pulmonary Arterial Hypertension: Systematic Review and Meta-analysis. Can J Cardiol 2014; 30:879-87. [DOI: 10.1016/j.cjca.2014.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022] Open
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Flessas N, Alexanian I, Parissis J, Kremastinos D, Lekakis J, Filippatos G. Plasma activity of B-type natriuretic peptide in patients with biventricular heart failure versus those with right heart failure due to chronic obstructive pulmonary disease. J Cardiovasc Med (Hagerstown) 2014; 15:476-80. [DOI: 10.2459/jcm.0000000000000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Begoña García-Navarro E. [Living with chronic heart failure: a review of qualitative studies in the elderly]. ENFERMERIA CLINICA 2014; 24:302-4. [PMID: 24866360 DOI: 10.1016/j.enfcli.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- E Begoña García-Navarro
- Departamento Enfermería, Facultad de Enfermería, Universidad de Huelva, Área Hospitalaria Juan Ramón Jiménez, Huelva, Huelva, España.
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Guerrero Orriach JL, Navarro Arce I, Iglesias P, Galán Ortega M, Rubio Navarro M, Cruz Mañas J. Tratamiento preoperatorio con levosimendán para paciente con disfunción ventricular derecha previa a cirugía de sustitución valvular. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Guerrero Orriach JL, Navarro Arce I, Iglesias P, Galán Ortega M, Rubio Navarro M, Cruz Mañas J. Preoperative levosimendan for right ventricular dysfunction before heart valve replacement surgery. ACTA ACUST UNITED AC 2013; 66:999-1000. [PMID: 24774116 DOI: 10.1016/j.rec.2013.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
Affiliation(s)
| | - Isabel Navarro Arce
- Servicio de Anestesiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Pablo Iglesias
- Servicio de Anestesiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Manuel Galán Ortega
- Servicio de Anestesiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Manuel Rubio Navarro
- Servicio de Anestesiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José Cruz Mañas
- Servicio de Anestesiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Heras M, Avanzas P, Bayes-Genis A, de Isla LP, Sanchis J. [Current Topics in Cardiology in 2011. Introduction: developments in 2011]. Rev Esp Cardiol 2012; 65 Suppl 1:1-3. [PMID: 22379618 DOI: 10.1016/j.recesp.2011.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Heras M, Avanzas P, Bayes-Genis A, Pérez de Isla L, Sanchis J. Annual summary 2010: bibliometric data, activities, and new production of the journal. Rev Esp Cardiol 2010; 63:1501-1509. [PMID: 21144416 DOI: 10.1016/s1885-5857(10)70286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Heras M, Avanzas P, Bayes-Genis A, de Isla LP, Sanchis J. Resumen anual año 2010: datos bibliométricos, actividades y nueva producción de la Revista. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70282-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Romano MA, Cowger J, Aaronson KD, Pagani FD. Diagnosis and Management of Right-Sided Heart Failure in Subjects Supported With Left Ventricular Assist Devices. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 12:420-30. [DOI: 10.1007/s11936-010-0091-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Antagonistas de la aldosterona: ¿de la cirrosis a la insuficiencia cardiaca? Rev Esp Cardiol (Engl Ed) 2010; 63:1001-2. [DOI: 10.1016/s0300-8932(10)70217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Méndez Bailón M, Muñoz-Rivas N, Ryan Murúa P, Troya García J. Aldosterone antagonists: from cirrhosis to heart failure? Rev Esp Cardiol 2010; 63:1001-1003. [PMID: 20738949 DOI: 10.1016/s1885-5857(10)70199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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