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The importance of right ventricular evaluation in risk assessment and therapeutic strategies: Raising the bar in pulmonary arterial hypertension

Badagliacca, Roberto ; Papa, Silvia ; Matsubara, Hiromi ; Lang, Irene Marthe ; Poscia, Roberto ; Manzi, Giovanna ; Vizza, Carmine Dario

International journal of cardiology, 2020-02, Vol.301, p.183-189 [Periódico revisado por pares]

Netherlands: Elsevier B.V

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Título:
The importance of right ventricular evaluation in risk assessment and therapeutic strategies: Raising the bar in pulmonary arterial hypertension
Autor: Badagliacca, Roberto ; Papa, Silvia ; Matsubara, Hiromi ; Lang, Irene Marthe ; Poscia, Roberto ; Manzi, Giovanna ; Vizza, Carmine Dario
Assuntos: Echocardiogram ; Echocardiography - methods ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Hemodynamic ; Hemodynamics ; Humans ; Patient Care Management - methods ; Pulmonary arterial hypertension ; Pulmonary Arterial Hypertension - diagnosis ; Pulmonary Arterial Hypertension - physiopathology ; Pulmonary Arterial Hypertension - therapy ; Pulmonary vascular resistance ; Right ventricle ; Vascular Resistance ; Ventricular Dysfunction, Right - diagnosis ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Dysfunction, Right - therapy
É parte de: International journal of cardiology, 2020-02, Vol.301, p.183-189
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-1
Descrição: Pulmonary arterial hypertension is an obstructive pulmonary vasculopathy that leads to increased pulmonary vascular resistance, right ventricular overload and failure, and death. Patients' clinical status and prognosis depend mostly on the capability of the right ventricle to adapt to the increased afterload, maintain function, and preserve cardiac output. As a result, reducing the hemodynamic burden of the right ventricle should be a key target of current treatments, along with improvement in WHO functional class, 6-minute walk distance, and rates of hospitalization. However, physicians still find it challenging to integrate the evaluation of right ventricular function into widely accepted clinical parameters in order to stratify patients more accurately. This limitation is very relevant, since higher-risk patients are more likely to benefit from a more aggressive therapeutic approach. We analyzed the hemodynamic burden in pulmonary arterial hypertension, the importance of echocardiographic evaluation of the right ventricle, the impact of current treatments on hemodynamic parameters, and the identification of patients who are more likely to benefit from a more aggressive therapeutic approach. •The right ventricle (RV) is the main determinant of patient's prognosis.•Afterload mismatch represents the pathophysiology-driven mechanism for RV failure.•A dramatic reduction in PVR is possible with parenteral prostanoids.•Rigorous multicenter studies are mandatory to clarify the appropriate treatment strategies.•Echo-derived RV evaluation has additive value in clinical practice.
Editor: Netherlands: Elsevier B.V
Idioma: Inglês

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The importance of right ventricular evaluation in risk assessment and therapeutic strategies: Raising the bar in pulmonary arterial hypertension

Badagliacca, Roberto ; Papa, Silvia ; Matsubara, Hiromi ; Lang, Irene Marthe ; Poscia, Roberto ; Manzi, Giovanna ; Vizza, Carmine Dario

Netherlands: Elsevier B.V

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