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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 : Contemporary management of acute RV failure

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          Abstract

          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.

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          Most cited references 114

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          Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

          The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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            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.

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              2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

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                Author and article information

                Journal
                European Journal of Heart Failure
                Eur J Heart Fail
                Wiley
                13889842
                March 2016
                March 2016
                March 15 2016
                : 18
                : 3
                : 226-241
                Affiliations
                [1 ]Emergency Medicine, Helsinki University; Department of Emergency Medicine and Services, Helsinki University Hospital; Helsinki Finland
                [2 ]University Paris Diderot; Sorbonne Paris Cité Paris France
                [3 ]U942 Inserm; AP-HP Paris France
                [4 ]APHP, Department of Anaesthesia and Critical Care; Hôpitaux Universitaires Saint Louis-Lariboisière; Paris France
                [5 ]Clinic of Cardiac and Vascular Diseases, Faculty of Medicine; Vilnius University; Vilnius Lithuania
                [6 ]Institute of Anaesthesiology; University Hospital Zurich; Switzerland
                [7 ]Centro Nacional de Investigaciones Cardiovasculares (CNIC)
                [8 ]Instituto de Investigación i + 12 and Cardiology Department; Hospital Universitario 12 de Octubre, Madrid, Spain
                [9 ]Universidad Complutense de Madrid; Spain
                [10 ]University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease; Bucharest Romania
                [11 ]Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco; Complexo Hospitalario Universitario A Coruna, CHUAC; La Coruna Spain
                [12 ]Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin Germany
                [13 ]Athens University Hospital Attikon; Athens Greece
                [14 ]Imperial College; London United Kingdom
                [15 ]Departamento de Fisiologia e Cirurgia Cardiotorácica; Faculdade de Medicina, Universidade do Porto; Porto Portugal
                [16 ]Cardiology, Helsinki University; Helsinki University Hospital; Helsinki Finland
                [17 ]Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet; University of Barcelona; Barcelona Spain
                [18 ]Department of Cardiology and Cardiovascular Research Institute Basel (CRIB); University Hospital Basel; Basel Switzerland
                [19 ]Department of Cardiology, Ziekenhuis Oost Limburg, Genk - Biomedical Research Institute, Faculty of Medicine and Life Sciences; Hasselt University; Diepenbeek Belgium
                [20 ]Department of Physiology, Faculty of Medicine; Free University of Brussels; Brussels Belgium
                [21 ]Vrije Universiteit Medisch Centrum; Amsterdam the Netherlands
                [22 ]Attikon University Hospital; Athens Greece
                [23 ]Department of Cardiology of the Clinical Centre of Serbia and; Belgrade University School of Medicine; Belgrade Serbia
                [24 ]IRCCS San Raffaele Hospital Roma; Rome Italy
                [25 ]Cardiovascular and Cell Sciences Institute; St George's University of London; London UK
                [26 ]Cardio-surgical Intensive Care Unit; University Hospital Zurich; Zurich Switzerland
                [27 ]Department of Cardiology, Heart Failure Clinic and Transplantation; University Heart Centre Zurich; Zurich Switzerland
                [28 ]Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre; Belgrade University Medical Centre; Belgrade Serbia
                [29 ]Réanimation polyvalente, Hôpital Antoine Béclère; Hôpitaux univeristaires Paris Sud; AP-HP Clamart France
                [30 ]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
                [31 ]Department of Cardiology; Cumhuriyet University Faculty of Medicine; Sivas Turkey
                [32 ]Centre for Thrombosis and Haemostasis (CTH); University Medical Centre Mainz; Mainz Germany
                [33 ]Department of Cardiology; Democritus University of Thrace; Alexandroupolis Greece
                10.1002/ejhf.478
                26995592
                © 2016

                http://doi.wiley.com/10.1002/tdm_license_1.1

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                Self URI (article page): http://doi.wiley.com/10.1002/ejhf.478

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