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Pulmonary Arterial Hypertension With Right Ventricular FailureAcute Right-sided Heart Failure: The Left Forgotten Ventricle

Benjamin H. Freed, MD; Mardi Gomberg-Maitland, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Gomberg-Maitland), University of Chicago; and the Department of Medicine (Dr Freed), Northwestern University.

Correspondence to: Mardi Gomberg-Maitland, MD, FCCP, 5841 S Maryland Ave, MC 5403, University of Chicago, Chicago, IL 60637; e-mail: mgomberg@bsd.uchicago.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: The University of Chicago has received research grant support from Actelion Pharmaceuticals Ltd; Gilead Sciences, Inc; GlaxoSmithKline; Medtronic, Inc; and Novartis for Dr Gomberg-Maitland as principal investigator. Dr Gomberg-Maitland has served as a consultant to and/or on an advisory board/steering committee/data safety monitoring board for Actelion Pharmaceuticals Ltd; Gilead Sciences, Inc; Medtronic, Inc; Merck & Co, Inc; and Pfizer, Inc. Dr Freed has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1435-1436. doi:10.1378/chest.13-1193
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Right ventricular failure (RVF) is a complex clinical syndrome of impaired filling or ejection of blood from the right ventricle. As a syndrome of newly recognized clinical importance, with diverse causes, its clinical epidemiology is not well characterized.1 For patients with advanced pulmonary arterial hypertension (PAH), acute RVF exacerbations have an estimated 29% to 41% mortality rate.2,3 Despite the high mortality rate, acute RVF management continues to be based on animal data and anecdotal clinical experience.4,5 In addition, the only known prognostic factors for acute RVF in PAH are based on simple clinical (mean systemic arterial pressure, respiratory rate), laboratory (estimated glomerular filtration rate), and imaging (tricuspid regurgitation velocity) measures, which reflect impaired right ventricular (RV) function and systemic hypoperfusion.2,3 A better characterization of the presentation and the interventricular interdependence in patients with PAH and acute RVF could improve prognostication and clinical care.

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