Anne-Marie Koop

1 11 Definition of right ventricular failure Right sided heart failure is a clinical syndrome with sypmtoms as epigastric fullness, ankle swelling and fatigue.(see table 1 ) as a result of changes in structure and function of the right heart circulatory system. 12 The right ventricle plays a central role in the development of right sided heart failure. The inability to adequately pump blood into the lungs and the increased stiffness of the RV leads to increased central venous pressure (CVP) and reduced LV filling. 2,13 This results from the reduced RV stroke volume and the interventricular dependence as a consequence of RV dilatation. Both congestion (backward failure) and reduced cardiac output (forward failure) contribute to impaired organ function. RV failure may lead to hepatic congestion with subsequent laboratory abnormalities in the liver integral. 14,15 Renal function is predominantly affected by the increase of CVP, 16 but also by the insufficient circulation as a result of forward failure, leading to fluid retention and reduced urine output. 13 Reduced gastrointestinal absorption and malnutrition can be the consequence of both reduced CO and increased CVP, where the latter contributes to deficient abdominal lymph flow leading to interstitial and visceral oedema. 17 This mechanism also applies to the lung, where decreased lymphatic drainage contributes to pulmonary oedema and pleural effusions. 2 Table 1. Clinical presentation of RV failure. Symptoms, e.g.: - epigastric fullness, - right upper abdominal discomfort, - ankle swelling, - dyspnea or tachypnea, and - fatigue. Signs, e.g.: - jugular venous distention, - third heart sound, - hepatomegaly, - ascites, and - peripheral oedema. Determination of RV dysfunction RVdysfunctionprecedesRVfailure and is reflectedbyworseningofRVhemodynamic parameters derived by echocardiography, cardiac magnetic resonance imaging (CMR) or heart catheterization. Early recognition of RV dysfunction is important to halt further deterioration of RV function and clinical status. Contraction of the RV is a movement against the septum, ending with a wringing movement in longitudinal direction. Most frequently used parameter of RVsystolic function is based on this longitudinal function derived by echocardiography: the tricuspid annular plane systolic excursion (TAPSE). Although this marker may be of prognostic value in various diseases, 18,19 it incompletely reflects RV systolic function. In addition, Early recognition of RV dysfunction is important to halt further deterioration of RV function and clinical status.