Right Heart Adaptation to Pulmonary Arterial€Hypertension

From the *Departm the Netherlands; y Stanford Universi Pulmonary Divisio Texas; xPulmona University Hospit University of Pe Cardiovascular D #Department of P Brussels, Belgium; Critical Care Med nessee; yyThe Dav Hypertension, Div UCLA Medical C Group, Centre de mologie de Québ Pulmonary Circul Medical Education Care Medicine an wealth University, more, Maryland. Bayer, GlaxoSmith industry advisory urvival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation. (J Am Coll Cardiol 2013;62:D22–33) a 2013 by the American College of Cardiology Foundation