Left heart pathology and right ventricle function

Abstract

Pulmonary hypertension and right ventricular dysfunction are both common in left-sided heart failure. The classical belief that in leftsided heart disease, right ventricular dysfunction develops secondary to pulmonary hypertension is not always true and exceptions to this rule may occur frequently in clinical practice. The shared myofibers between left and right ventricles, the dysfunctional interventricular septum and the shared pericardium are more important mechanisms of right ventricular dysfunction in left heart failure. As pulmonary hypertension and right ventricular dysfunction do not always coexist in the same patient, they have independent prognostic value, and therefore each of them should be regarded as separate entities in the process of risk stratification of patients with left heart failure. In this chapter we discuss the currently accepted mechanisms of right ventricular damage in the context of left heart disease. We also present epidemiological data as well as the predictive value of right ventricular dysfunction in some of the most frequent etiologies of left heart failure such as heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, aortic stenosis and mitral regurgitation.