Right Ventricular Fibrosis - a pathophysiological factor in pulmonary hypertension?

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Stine Andersen
  • Jens Erik Nielsen-Kudsk
  • Anton Vonk Noordegraaf, Amsterdam UMC, Vrije Universiteit, The Netherlands (A.V.N., F.S.d.M)., Frances S de Man, Amsterdam UMC, Vrije Universiteit, The Netherlands (A.V.N., F.S.d.M).

The role of right ventricular (RV) fibrosis in pulmonary hypertension (PH) remains a subject of ongoing discussion. Alterations of the collagen network of the extracellular matrix may help prevent ventricular dilatation in the pressure-overloaded RV. At the same time, fibrosis impairs cardiac function, and a growing body of experimental data suggests that fibrosis plays a crucial role in the development of RV failure. In idiopathic pulmonary arterial hypertension and chronic thromboembolic PH, the RV is exposed to a ≈5 times increased afterload, which makes these conditions excellent models for studying the impact of pressure overload on RV structure. With this review, we present clinical evidence of RV fibrosis in idiopathic pulmonary arterial hypertension and chronic thromboembolic PH, explore the correlation between fibrosis and RV function, and discuss the clinical relevance of RV fibrosis in patients with PH. We postulate that RV fibrosis has a dual role in patients with pressure-overloaded RVs of idiopathic pulmonary arterial hypertension and chronic thromboembolic PH: as part of an adaptive response to prevent cardiomyocyte overstretch and to maintain RV shape for optimal function, and as part of a maladaptive response that increases diastolic stiffness, perturbs cardiomyocyte excitation-contraction coupling, and disrupts the coordination of myocardial contraction. Finally, we discuss potential novel therapeutic strategies and describe more sensitive techniques to quantify RV fibrosis, which may be used to clarify the causal relation between RV fibrosis and RV function in future research.

OriginalsprogEngelsk
TidsskriftCirculation
Vol/bind139
Tidsskriftsnummer2
Sider (fra-til)269-285
Antal sider17
ISSN0009-7330
DOI
StatusUdgivet - 8 jan. 2019

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