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Clinical Cardiology Jul 2017A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies... (Review)
Review
BACKGROUND
A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic.
HYPOTHESIS
Chemotherapy induces RV structural, functional, and mechanical changes.
METHODS
We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab."
RESULTS
The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment.
CONCLUSIONS
Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.
Topics: Antineoplastic Agents; Diastole; Echocardiography; Heart Failure; Heart Ventricles; Humans; Neoplasms; Stroke Volume; Systole; Ventricular Dysfunction, Right; Ventricular Function, Right; Ventricular Remodeling
PubMed: 28191909
DOI: 10.1002/clc.22672 -
Chest Mar 2015In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the... (Review)
Review
In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
Topics: Acute Disease; Critical Illness; Echocardiography; Fluid Therapy; Heart Ventricles; Humans; Prevalence; Respiration, Artificial; Ventricular Dysfunction, Right
PubMed: 25732449
DOI: 10.1378/chest.14-1335 -
Interventional Cardiology Clinics Jul 2017Pulmonary hypertension (PH) falls into 5 groups, as defined by the World Health Organization. Swan-Ganz catheters determine precapillary versus postcapillary PH. The... (Review)
Review
Pulmonary hypertension (PH) falls into 5 groups, as defined by the World Health Organization. Swan-Ganz catheters determine precapillary versus postcapillary PH. The hemodynamic values of PH at rest and with vasodilatory challenge categorize the etiology of PH and guide treatment. RV maladaptations to increased pulmonary vascular resistance (PVR) and the chronicity of the right ventricle's (RV) response to increased PH and/or increased PVR can be understood with pressure-volume (PV) loops constructed with use of conductance catheters. These PV loops demonstrate the RV's ability to increase stroke volume in acutely and chronically increased PVR.
Topics: Cardiac Catheterization; Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Monitoring, Physiologic; Pulmonary Artery
PubMed: 28600088
DOI: 10.1016/j.iccl.2017.03.004 -
Current Cardiology Reports Jun 2024This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac... (Review)
Review
PURPOSE OF REVIEW
This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac surgery, cardiac interventions, and congenital heart disease.
RECENT FINDINGS
The need for more accessible clinical means of evaluation of RV-PA coupling has driven researchers to investigate surrogates using cardiac MRI, echocardiography, and right-sided pressure measurements in patients undergoing cardiac surgery/interventions, as well as patients with congenital heart disease. Recent research has aimed to validate these alternative means against the gold standard, as well as establish cut-off values predictive of morbidity and/or mortality. This emerging evidence lays the groundwork for identifying appropriate RV-PA coupling surrogates and integrating them into perioperative clinical practice.
Topics: Humans; Pulmonary Artery; Heart Defects, Congenital; Cardiac Surgical Procedures; Heart Ventricles; Ventricular Function, Right; Echocardiography; Magnetic Resonance Imaging
PubMed: 38581563
DOI: 10.1007/s11886-024-02052-3 -
The Journal of Heart and Lung... Jul 2017Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular...
Despite significant efforts to predict and prevent right heart failure, it remains a leading cause of morbidity and mortality after implantation of left ventricular assist systems (LVAS). In this Perspective, we review the underappreciated anatomic and physiologic principles that govern the relationship between left and right heart function and contribute to this phenomenon. This includes the importance of considering the right ventricle (RV) and pulmonary arterial circuit as a coupled system; the contribution of the left ventricle (LV) to RV contractile function and the potential negative impact of acutely unloading the LV; the influence of the pericardium and ventricular twist on septal function; the role of RV deformation in reduced mechanical efficiency after device placement; and the potential of ongoing stressors of an elevated right-sided preload. We believe an appreciation of these complex issues is required to fully understand the expression of the unique phenotypes of right heart failure after LVAS implantation and for developing better prognostic and therapeutic strategies.
Topics: Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans; Ventricular Dysfunction, Right
PubMed: 28416103
DOI: 10.1016/j.healun.2017.03.014 -
Journal of the American College of... Feb 2022
Topics: Cardiac Surgical Procedures; Heart Ventricles; Humans; Pulmonary Artery; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 35115102
DOI: 10.1016/j.jacc.2021.11.030 -
Arquivos Brasileiros de Cardiologia Oct 2021
Topics: Echocardiography; Heart Ventricles; Humans; Pulmonary Valve Insufficiency
PubMed: 34709297
DOI: 10.36660/abc.20210744 -
Heart Failure Clinics Jul 2018Echocardiography is the first step in imaging the right heart pulmonary circulation unit (RH-PCU), and the only one to allow its complete morphologic, functional, and... (Review)
Review
Echocardiography is the first step in imaging the right heart pulmonary circulation unit (RH-PCU), and the only one to allow its complete morphologic, functional, and hemodynamic analysis in all clinical scenarios. Right ventricular (RV) function is not only the consequence of its intrinsic contractile function (morphology and contractility) but also highly dependent on preload, afterload, and ventricular interdependence. Comprehensive echocardiographic examination of RH-PCU allows insight into intrinsic and extrinsic factors of RV function. Newer echocardiographic techniques allow for 3-dimensional evaluation of RV and detailed measurements of regional function using tissue Doppler or speckle tracking-based strain estimates.
Topics: Echocardiography; Heart Ventricles; Hemodynamics; Humans; Pulmonary Circulation; Ventricular Function, Right
PubMed: 29966634
DOI: 10.1016/j.hfc.2018.03.003 -
The Heart Surgery Forum Aug 2021Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left ventricle and/or right ventricle. Most previous studies mainly include the left ventricle for definition of HCM, thus neglecting the right ventricle. But recently, many studies have reported the right ventricular involvement in HCM. Histopathological results showed that similar pathogenic changes in both the right and left ventricles, which suggests common myopathic processes and sarcomere genetic mutations. Cardiovascular magnetic resonance (CMR) is a gold standard imaging modality to assess heart anatomy and function and provides highly accurate and reproducible measurements. CMR is very useful in characterizing the various phenotypes of right and left ventricles in HCM. CMR also can be useful in detecting early and dominant phenotypic expression of HCM. Due to the complex geometry of the right ventricle and its retrosternal position, echocardiography may not provide accurate measurements. CMR also provides more accurate and repeatable right ventricular measurements. Thus, right ventricle evaluation along with left ventricle should routinely be done for better assessment of HCM patients.
Topics: Cardiomyopathy, Hypertrophic; Heart Ventricles; Humans; Magnetic Resonance Imaging; Ventricular Dysfunction, Right
PubMed: 34473022
DOI: 10.1532/hsf.3977 -
The Journal of Thoracic and... Sep 2022
Topics: Coronary Circulation; Heart Ventricles; Humans; Pulmonary Atresia; Treatment Outcome; Ventricular Septum
PubMed: 35183362
DOI: 10.1016/j.jtcvs.2022.01.027