Abstract
Right ventricle (RV) is considered a neglected chamber in cardiology and knowledge about its role in cardiac function was mostly focused on ventricular interdependence. However, progress on the understanding of myocardium diseases primarily involving the RV led to a better comprehension of its role in health and disease. In Chagas disease (CD), there is direct evidence from both basic and clinical research of profound structural RV abnormalities. However, clinical detection of these abnormalities is hindered by technical limitations of imaging diagnostic tools. Echocardiography has been a widespread and low-cost option for the study of patients with CD but, when applied to the RV assessment, faces difficulties such as the absence of a geometrical shape to represent this cavity. More recently, the technique has evolved to a focused guided RV imaging and myocardial deformation analysis. Also, cardiac magnetic resonance (CMR) has been introduced as a gold standard method to evaluate RV cavity volumes. CMR advantages include precise quantitative analyses of both LV and RV volumes and its ability to perform myocardium tissue characterization to identify areas of scar and edema. Evolution of these cardiac diagnostic techniques opened a new path to explore the pathophysiology of RV dysfunction in CD.
Highlights
Physiology concepts about heart function considered the right ventricle as a kind of almost perfunctory chamber, knowledge about ventricle interdependence was well recognized decades ago [1]
The systolic interplay has been primarily demonstrated as the predominant influence the left ventricle exerts upon the right ventricle. This is because the opposite effect of lower systolic pressure of right ventricle influencing left ventricle performance is usually minimized under normal physiologic conditions
This review explores the right ventricle anatomic and functional involvement in Chagas cardiomyopathy (CC) while highlighting the contribution of cardiac imaging diagnostic methods in the field
Summary
Physiology concepts about heart function considered the right ventricle as a kind of almost perfunctory chamber, knowledge about ventricle interdependence was well recognized decades ago [1]. It is noteworthy that, in cases of reactivation of T. cruzi infection in immune suppressed patients, a remarkable degree of RV dilation and systolic dysfunction has been described [43,44,45] Despite these findings, some controversy occurs in the literature regarding the detection of clinically apparent early right ventricle involvement in CC. The results from the study with radionuclide angiography, coupled with previous anatomopathologic data already discussed, produced the hypothesis that RV myocardial damage may be an early and direct pathophysiological consequence of CC This hypothesis comprehends the notion that, in a scenario of low vascular pulmonary resistance (i.e., in the absence of LV systolic and diastolic dysfunction and its retrograde effects upon the pulmonary circulation), no clinical manifestations of the RV functional impairment would be detectable. The impact of RBBB in CD as a primary mechanism to RV mechanical dyssynchrony and dysfunction warrants further investigation with dedicated study design
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