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The right ventricle and pulmonary hypertension

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Abstract

In patients with pulmonary hypertension (PH), the primary cause of death is right ventricular (RV) failure. Improvement in RV function is therefore one of the most important treatment goals. In order to be able to reverse RV dysfunction and also prevent RV failure, a detailed understanding of the pathobiology of RV failure and the underlying mechanisms concerning the transition from a pressure-overloaded adapted right ventricle to a dilated and failing right ventricle is required. Here, we propose that insufficient RV contractility, myocardial fibrosis, capillary rarefaction, and a disturbed metabolism are important features of a failing right ventricle. Furthermore, an overview is provided about the potential direct RV effects of PH-targeted therapies and the effects of RV-directed medical treatments.

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Acknowledgments

We acknowledge the support from the Netherlands CardioVascular Research Initiative, the Dutch Heart Foundation, Dutch Federation of University Medical Centres, the Netherlands Organisation for Health Research and Development, and the Royal Netherlands Academy of Sciences.

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Authors and Affiliations

  1. Department of Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands

    Mariëlle C. van de Veerdonk & Harm J. Bogaard

  2. The Victoria Johnson Pulmonary Research Laboratory, Virginia Commonwealth University, 1220 East Broad Street, Richmond, VA, 23298, USA

    Norbert F. Voelkel

Authors
  1. Mariëlle C. van de Veerdonk
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  2. Harm J. Bogaard
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  3. Norbert F. Voelkel
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Correspondence to Norbert F. Voelkel.

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Conflict of interest

Dr. M.C. van de Veerdonk declares that she has no conflicts of interest or financial ties to disclose. Dr. H.J. Bogaard receives speaker fees form Actelion, Pfizer, Bayer and is part of the advisory board of United Therapeutics and has received grant support from Boehringer Ingelheim and the Lung Foundation. Dr. N.F. Voelkel is part of the advisory board of Actelion and is a consultant at Insmed.

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van de Veerdonk, M.C., Bogaard, H.J. & Voelkel, N.F. The right ventricle and pulmonary hypertension. Heart Fail Rev 21, 259–271 (2016). https://doi.org/10.1007/s10741-016-9526-y

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