Editorial comment
The right ventricle in advanced heart failure: The dark side of the moon
O ventrículo direito na insuficiência cardíaca avançada: o lado escuro da Lua
Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Baydar, Nuran Yazicioglu, Nurcan Arat Koc" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ebru" "apellidos" => "Ozenc" ] 1 => array:2 [ "nombre" => "Omer" "apellidos" => "Yildiz" ] 2 => array:2 [ "nombre" => "Onur" "apellidos" => "Baydar" ] 3 => array:2 [ "nombre" => "Nuran" "apellidos" => "Yazicioglu" ] 4 => array:2 [ "nombre" => "Nurcan Arat" "apellidos" => "Koc" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920303603?idApp=UINPBA00004E" "url" => "/21742049/0000003900000010/v1_202012250814/S2174204920303603/v1_202012250814/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The right ventricle in advanced heart failure: The dark side of the moon" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "573" "paginaFinal" => "574" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mariana Brandão, Daniel Caeiro" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mariana" "apellidos" => "Brandão" ] 1 => array:4 [ "nombre" => "Daniel" "apellidos" => "Caeiro" "email" => array:1 [ 0 => "danicaeiro@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "O ventrículo direito na insuficiência cardíaca avançada: o lado escuro da Lua" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure (HF) is a leading cause of death and hospitalization, imposing a heavy burden, not only on patients and their families, but also on society.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> In recent years, various advances, including new drugs, cutting-edge devices and innovative therapeutic strategies, have improved the longevity and quality of life of HF patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> Unfortunately, though, not all patients derive the maximum benefit from such approaches, and many do not exhibit a favorable clinical response. Inability to tolerate drug treatment, or merely an unsatisfactory response to interventions, are among the factors that result in an unsuccessful path in chronic HF.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> HF patients frequently require medical attention, with regular visits to emergency departments and hospital admissions, often in high-dependency units. Such events are well-recognized predictors of mortality.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> Identifying high-risk patients solely on clinical grounds is often a hard and inglorious task. This has prompted a search for biochemical and imaging parameters to aid clinical assessment and the identification of patients at higher risk for adverse events and death.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Left ventricular ejection fraction (LVEF) is a long-time favorite and extensively evaluated tool<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> that is a good prognostic marker in HF patients. It is widely available, easily obtainable and (relatively) reproducible. However, in patients with more severe ventricular dysfunction, it loses its ability to predict events. Of note, in many patients, LVEF does not correlate well with functional capacity or quality of life.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The measurement of right ventricular (RV) function, historically overshadowed by its left counterpart, is often metaphorically compared to the dark side of the moon: less accessible and often disregarded. Currently, there is growing interest in the pathophysiologic role and prognostic relevance of the right ventricle in advanced HF. However, objective, reliable, and reproducible assessment of RV function is often difficult. Several methods have been advocated, but all are far from perfect, and this constitutes an important limitation to the use of RV functional parameters in daily clinical practice.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In their article<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span>, Ozenc and coworkers explore the role of data obtained from right heart catheterization as a tool to assess a group of more severe patients, candidates for heart transplantation or left ventricular assist device (LVAD) implantation, most of them under optimal medical therapy as recommended by the ESC guidelines on Heart Failure from 2012.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As expected, a comprehensive data collection was performed. After non-invasive assessment by echocardiography and right heart catheterization, the only parameter that strongly predicted hospitalization was right ventricular stroke work index (RVSWI). Other commonly used non-invasive and hemodynamic parameters, such as LVEF, tricuspid annular plane systolic excursion, cardiac index or cardiac output, and pulmonary capillary wedge pressure (PCWP), did not have predictive value regarding HF hospitalizations. Moreover, none of the tools analyzed were found to predict mortality. The authors attributed this to the short follow-up time. The relatively low cardiovascular mortality (considering the high-risk features of this group of patients), more easily influenced by unexpected events or even arrhythmic episodes, may be another plausible explanation for the absence of significant predictors. Unfortunately no information was reported regarding implantable cardioverter-defibrillator use.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Notably, deceased patients displayed numerically lower cardiac output and index, as well as higher PCWP. Nonetheless, such differences were not statistically significant (probably due to the low event rate).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Right heart catheterization is an invasive procedure with non-negligible complications. Furthermore, it is not widely available and should be performed only in selected cases, by experienced operators. However, it remains part of the routine assessment of heart transplantation or LVAD candidates. The work by Ozenc et al. showed that measurement of RVSWI provides further valuable information in settings where right heart catheterization is required, without significantly increasing the complexity or risk of the procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Advanced HF involves complex clinical scenarios in which a ‘one size fits all’ assessment and management of patients is unlikely to result in satisfactory outcomes. The information added by RVSWI may enable more tailored management and follow-up in this particular setting, identifying patients who are at higher risk for unscheduled hospital admissions and in need of closer surveillance or anticipated advanced interventions. It might also prompt earlier referral for palliative care (often disregarded, but important to patients from their individual perspective).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Curiously, none of the enrolled patients underwent cardiac transplantation and no information regarding LVAD support is provided. It is possible that the authors, similarly to Portuguese heart failure specialists, face a harsh reality when it comes to access to heart transplantation and medium- and long-term LVAD therapy. Unfortunately, heart transplantation is becoming more and a more an epidemiological curiosity and access to LVAD, shamefully, a mirage.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment optimization in advanced heart failure is an ever-moving target: when acute HF stabilization is achieved, further down the road the same patient may return in a challenging chronic HF scenario, with an increased burden of age and comorbidities. However, meanwhile, providing our patients with the optimum strategy according to current best practice enables them to live a longer and happier life, and that is undoubtedly a great achievement for heart failure caregivers.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw128" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2129" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Roger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCRESAHA.113.300268" "Revista" => array:6 [ "tituloSerie" => "Circ Res" "fecha" => "2013" "volumen" => "113" "paginaInicial" => "646" "paginaFinal" => "659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23989710" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of left ventricular systolic dysfunction and heart failure in the Framingham Study: an echocardiographic study over three decades" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.S. Vasan" 1 => "V. Xanthakis" 2 => "A. Lyass" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol Image" "fecha" => "2018" "volumen" => "11" "paginaInicial" => "1" "paginaFinal" => "11" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of prognostic risk scores in chronic heart failure patients enrolled in the European Society of Cardiology Heart Failure Long-Term Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Canepa" 1 => "C. Fonseca" 2 => "O. Chioncel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol HF" "fecha" => "2018" "volumen" => "6" "paginaInicial" => "452" "paginaFinal" => "462" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traditional and novel imaging of right ventricular function in patients with heart failure and reduced ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Sciaccaluga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11897-020-00455-1" "Revista" => array:6 [ "tituloSerie" => "Curr Heart Fail Rep" "fecha" => "2020" "volumen" => "17" "paginaInicial" => "28" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32130642" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Ozenc" 1 => "O. Yildiz" 2 => "O. 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| 2024 February | 25 | 21 | 46 |
| 2024 January | 29 | 19 | 48 |
| 2023 December | 21 | 22 | 43 |
| 2023 November | 23 | 34 | 57 |
| 2023 October | 19 | 19 | 38 |
| 2023 September | 18 | 15 | 33 |
| 2023 August | 16 | 17 | 33 |
| 2023 July | 21 | 10 | 31 |
| 2023 June | 27 | 9 | 36 |
| 2023 May | 33 | 28 | 61 |
| 2023 April | 20 | 3 | 23 |
| 2023 March | 36 | 25 | 61 |
| 2023 February | 26 | 21 | 47 |
| 2023 January | 28 | 15 | 43 |
| 2022 December | 43 | 30 | 73 |
| 2022 November | 29 | 26 | 55 |
| 2022 October | 35 | 29 | 64 |
| 2022 September | 28 | 33 | 61 |
| 2022 August | 34 | 29 | 63 |
| 2022 July | 20 | 37 | 57 |
| 2022 June | 18 | 27 | 45 |
| 2022 May | 18 | 21 | 39 |
| 2022 April | 28 | 33 | 61 |
| 2022 March | 23 | 40 | 63 |
| 2022 February | 24 | 28 | 52 |
| 2022 January | 19 | 25 | 44 |
| 2021 December | 24 | 34 | 58 |
| 2021 November | 23 | 27 | 50 |
| 2021 October | 31 | 48 | 79 |
| 2021 September | 25 | 25 | 50 |
| 2021 August | 21 | 33 | 54 |
| 2021 July | 13 | 24 | 37 |
| 2021 June | 19 | 15 | 34 |
| 2021 May | 18 | 38 | 56 |
| 2021 April | 64 | 50 | 114 |
| 2021 March | 38 | 18 | 56 |
| 2021 February | 27 | 14 | 41 |
| 2021 January | 28 | 18 | 46 |
| 2020 December | 11 | 3 | 14 |
Show all
