Author + information
- Received October 2, 2018
- Revision received December 12, 2018
- Accepted December 22, 2018
- Published online March 25, 2019.
- Javier Sanz, MDa,b,∗ (, )@MountSinaiNYC,
- Damián Sánchez-Quintana, MD, PhDc,
- Eduardo Bossone, MD, PhDd,
- Harm J. Bogaard, MD, PhDe and
- Robert Naeije, MD, PhDf
- aIcahn School of Medicine at Mount Sinai, New York, New York
- bCentro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- cDepartment of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
- dCardiology Division, “A. Cardarelli” Hospital, Naples, Italy
- eAmsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, Cardiovascular Sciences, Amsterdam, the Netherlands
- fDepartment of Pathophysiology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- ↵∗Address for correspondence:
Dr. Javier Sanz, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
• Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining symptoms and outcomes in multiple conditions.
• The normal RV is coupled to the low-pressure, high-compliance pulmonary circulation to ensure transfer of blood to the pulmonary arteries in an energy efficient fashion. RV adaptation to disease is determined by the degree of pressure overload, volume overload, and alterations in intrinsic contractility, 3 situations with distinct clinical course and therapeutic approach although commonly coexisting in various degrees.
• Refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, and function, and of its degree of coupling (or lack thereof) to the pulmonary circulation, either invasively or increasingly through noninvasive imaging, promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions.
There is increasing recognition of the crucial role of the right ventricle (RV) in determining functional status and prognosis in multiple conditions. The normal RV is anatomically and functionally different from the left ventricle, which precludes direct extrapolation of our knowledge of left-sided physiopathology to the right heart. RV adaptation is largely determined by the level of exposure to hemodynamic overload (both preload and afterload) as well as its intrinsic contractile function. These 3 processes (pressure overload, volume overload, and RV cardiomyopathy) are associated with distinct clinical course and therapeutic approach, although in reality they often coexist in various degrees. The close relationship between the RV and left ventricle (ventricular interdependence) and its coupling to the pulmonary circulation further modulate RV behavior in different clinical scenarios. In this review, the authors summarize current knowledge of RV anatomic, structural, metabolic, functional, and hemodynamic characteristics in both health and disease.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Marvin A. Konstam, MD, served as Guest Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received October 2, 2018.
- Revision received December 12, 2018.
- Accepted December 22, 2018.
- 2019 American College of Cardiology Foundation