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Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.

  • Harjola VP Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
  • Mebazaa A University Paris Diderot, Sorbonne Paris Cité, Paris, France.
  • Čelutkienė J Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • Bettex D Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
  • Bueno H Centro Nacional de Investigaciones Cardiovasculares (CNIC).
  • Chioncel O University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania.
  • Crespo-Leiro MG Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain.
  • Falk V Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
  • Filippatos G Athens University Hospital Attikon, Athens, Greece.
  • Gibbs S Imperial College, London, United Kingdom.
  • Leite-Moreira A Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
  • Lassus J Cardiology, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
  • Masip J Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, University of Barcelona, Barcelona, Spain.
  • Mueller C Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
  • Mullens W Department of Cardiology, Ziekenhuis Oost Limburg, Genk - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
  • Naeije R Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium.
  • Nordegraaf AV Vrije Universiteit Medisch Centrum, Amsterdam, the Netherlands.
  • Parissis J Attikon University Hospital, Athens, Greece.
  • Riley JP Imperial College, London, United Kingdom.
  • Ristic A Department of Cardiology of the Clinical Centre of Serbia and, Belgrade University School of Medicine, Belgrade, Serbia.
  • Rosano G IRCCS San Raffaele Hospital Roma, Rome, Italy.
  • Rudiger A Cardio-surgical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland.
  • Ruschitzka F Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland.
  • Seferovic P Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia.
  • Sztrymf B Réanimation polyvalente, Hôpital Antoine Béclère, Hôpitaux univeristaires Paris Sud, AP-HP, Clamart, France.
  • Vieillard-Baron A INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
  • Yilmaz MB Department of Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
  • Konstantinides S Centre for Thrombosis and Haemostasis (CTH), University Medical Centre Mainz, Mainz, Germany.
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  • 2016-03-21
Published in:
  • European journal of heart failure. - 2016
Cardiogenic shock
Heart failure
Intensive care
Right ventricular dysfunction
Right ventricular function
Echocardiography
Heart Failure
Humans
Pulmonary Circulation
Ventricular Dysfunction, Right
English Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.
Language
  • English
Open access status
bronze
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https://sonar.ch/global/documents/41818
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