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Editorials |

MRI : One-Stop Shop for the Comprehensive Assessment of Pulmonary Arterial Hypertension?

Jayan Nagendran, MD; Evangelos Michelakis, MD
Author and Funding Information

Affiliations: Edmonton, AB, Canada ,  Dr. Michelakis is Canada Research Chair in Pulmonary Hypertension and Director of Pulmonary Hypertension Program; and Dr. Nagendran is Cardiovascular Surgery Resident and Research Fellow, Pulmonary Hypertension Program, University of Alberta Hospitals.

Correspondence to: Evangelos D. Michelakis, MD, Canada Research Chair in Pulmonary Hypertension, Pulmonary Hypertension Program, Division of Cardiology, Department of Medicine, University of Alberta Hospitals, Edmonton, AB, T6G2B7 Canada; e-mail: emichela@cha.ab.ca



Chest. 2007;132(1):2-5. doi:10.1378/chest.07-0563
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Pulmonary arterial hypertension (PAH) is a complex disease that affects the right-sided circulation, including the right ventricle (RV) and the pulmonary vasculature. An obliterative remodeling in the vascular wall, characterized by increased cellular proliferation and suppressed apoptosis,1 leads to occlusion of pulmonary arteries (PAs), increased RV afterload, RV failure, and premature death. Emerging therapies target the proliferation/apoptosis of vascular cells, rather than vascular tone, that characterized PAH therapeutics during the past 50 years.25 Despite the progress in the vascular biology of PAH, there is an impressive relative lack of studies of the RV in both animals and humans. This is despite the recognition that both the morbidity and mortality of PAH patients are largely driven by the function of the RV.6 Traditionally, studies of the heart focus on the systemic circulation and the left ventricle (LV), and effects on the RV are merely extrapolated from the LV. However, there is recent recognition that there are several fundamental differences between the RV and LV, including their responses to increased afterload and their perfusion, among others.6 Intriguingly, the two ventricles have a different embryologic origin.7 Accordingly, there is now a call for further research regarding the RV with an RV-specific request for proposal by the National Institutes of Health (NIH) as well as an NIH subcommittee taskforce for the promotion of research and understanding of RV biology.6

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