The right ventricle in heart failure with preserved ejection fraction

The classic image of heart failure consists of patients with reduced systolic function of the left ventricle. However, approximately half of all patients with heart failure have a preserved systolic function. Symptoms of heart failure in this group are primarily caused by reduced relaxation of a stiff left ventricle. Mortality in these patients is high, and there are currently no therapies available that improve prognosis. The treatment of this group is difficult, because of the high heterogeneity of the disease and high prevalence of other factors such as older age, high blood pressure, obesity and diabetes.

Although these patients mainly have an impairment of the left ventricle, the present research of Thomas Gorter shows that reduced right ventricular function is also highly prevalent. Moreover, impaired right ventricular function is highly associated with reduced exercise capacity and poor prognosis. The most important cause of reduced right ventricular function is high blood pressure in the pulmonary circulation, which results in chronic overload of the right ventricle and higher hospital admission rate for heart failure. Furthermore, diabetes, atherosclerosis and atrial fibrillation are associated with impaired right ventricular function.

Gorter states that closely monitoring and adequate treatment with diuretics is essential in these patients, to inhibit further deterioration of the right ventricle and to reduce the risk of heart failure hospitalizations. In addition, several specific drugs are discussed that might reduce elevated blood pressure in the lungs, especially in heart failure patients with severely elevated pulmonary vascular resistance.