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Resynchronization therapy for right ventricular failure: restoring harmony in left ventricular contractility

  • Anthony R. Cucci
    Affiliations
    Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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  • Tim Lahm
    Correspondence
    Corresponding author. 980 W. Walnut Street, R3/Walther Hall, Room C400, Indianapolis, IN 46202. Tel.: +1 317 278 4013; fax: +1 317 278 7030.
    Affiliations
    Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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Published:August 31, 2012DOI:https://doi.org/10.1016/j.jss.2012.08.045
      Right ventricular failure (RVF) represents a formidable clinical challenge that carries significant morbidity and mortality [
      • Haddad F.
      • Doyle R.
      • Murphy D.J.
      • Hunt S.A.
      Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.
      ]. The management is mainly focused on the treatment of the underlying condition, with additional interventions aimed at optimizing preload, afterload, and contractility [
      • Haddad F.
      • Doyle R.
      • Murphy D.J.
      • Hunt S.A.
      Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.
      ,
      • Greyson C.R.
      Pathophysiology of right ventricular failure.
      ]. However, there is a lack of therapies that specifically target the dysfunctional right ventricle (RV). Recent studies have identified the importance of interventricular interactions, right and left ventricular (LV) dyssynchrony, and subsequent impairment of LV function in the setting of RVF [
      • Lopez-Candales A.
      • Dohi K.
      • Rajagopalan N.
      • et al.
      Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class.
      ,
      • Kalogeropoulos A.P.
      • Georgiopoulou V.V.
      • Howell S.
      • et al.
      Evaluation of right intraventricular dyssynchrony by two-dimensional strain echocardiography in patients with pulmonary arterial hypertension.
      ,
      • Kasner M.
      • Westermann D.
      • Steendijk P.
      • et al.
      Left ventricular dysfunction induced by nonsevere idiopathic pulmonary arterial hypertension: a pressure-volume relationship study.
      ]. Novel echocardiographic techniques have enabled objective quantification of both ventricular dyssynchrony and myocardial contractility. One novel approach of echocardiographic imaging is known as speckle tracking echocardiography (STE). Because of its sensitive assessment of myocardial contractility and lack of preload dependence, STE has propelled our understanding of ventricular dyssynchrony and its consequences on overall cardiac function [
      • Dohi K.
      • Onishi K.
      • Gorcsan 3rd, J.
      • et al.
      Role of radial strain and displacement imaging to quantify wall motion dyssynchrony in patients with left ventricular mechanical dyssynchrony and chronic right ventricular pressure overload.
      ,
      • Suffoletto M.S.
      • Dohi K.
      • Cannesson M.
      • Saba S.
      • Gorcsan 3rd, J.
      Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy.
      ]. Consequently, STE may help in the evaluation of novel therapeutic interventions for RVF.
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