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Right heart in pulmonary hypertension: from adaptation to failure

机译：肺动脉高压的右心：从适应失败

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Right ventricular (RV) failure (RVF) has garnered significant attention in recent years because of its negative impact on clinical outcomes in patients with pulmonary hypertension (PH). PH triggers a series of events, including activation of several signaling pathways that regulate cell growth, metabolism, extracellular matrix remodeling, and energy production. These processes render the RV adaptive to PH. However, RVF develops when PH persists, accompanied by RV ischemia, alterations in substrate and mitochondrial energy metabolism, increased free oxygen radicals, increased cell loss, downregulation of adrenergic receptors, increased inflammation and fibrosis, and pathologic microRNAs. Diastolic dysfunction is also an integral part of RVF. Emerging noninvasive technologies such as molecular or metallic imaging, cardiac MRI, and ultrafast Doppler coronary flow mapping will be valuable tools to monitor RVF, especially the transition to RVF. Most PH therapies cannot treat RVF once it has occurred. A variety of therapies are available to treat acute and chronic RVF, but they are mainly supportive, and no effective therapy directly targets the failing RV. Therapies that target cell growth, cellular metabolism, oxidative stress, and myocyte regeneration are being tested preclinically. Future research should include establishing novel RVF models based on existing models, increasing use of human samples, creating human stem cell-based in vitro models, and characterizing alterations in cardiac excitation–contraction coupling during transition from adaptive RV to RVF. More successful strategies to manage RVF will likely be developed as we learn more about the transition from adaptive remodeling to maladaptive RVF in the future.
机译：右心室（RV）失败（RVF）近年来恢复了重大关注，因为它对肺动脉高压患者（pH）患者的临床结果产生负面影响。 pH触发了一系列事件，包括激活几种调节细胞生长，新陈代谢，细胞外基质重塑和能量产生的信号通路。这些过程使RV适应pH。然而，RVF在pH持续存在时，伴随着RV缺血，底物和线粒体能量代谢的改变，增加游离氧自由基，增加的细胞损失，肾上腺素能受体的下调，增加的炎症和纤维化，以及病理微腹部。舒张功能障碍也是RVF的一部分。诸如分子或金属成像，心脏MRI和超快多普勒冠状动脉测绘的新兴的非侵入性技术将是监测RVF的有价值的工具，尤其是对RVF的过渡。大多数pH治疗方法发生后无法治疗RVF。可以治疗各种疗法来治疗急性和慢性RVF，但它们主要是支持性的，并且没有有效的治疗直接针对失败的RV。靶向细胞生长，细胞代谢，氧化应激和肌细胞再生的疗法尿液尿液呈现。未来的研究应包括基于现有模型建立新型RVF模型，增加人类样品的使用，从自适应RV转换期间，在从自适应RV到RVF的转变期间表征了人干细胞的体外模型，并表征了心脏激发收缩耦合的改变。可以更加成功地管理RVF的策略，因为我们将来更多地了解从自适应重塑到未来的适应性RVF过渡。

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