Neurohormonal modulation in right ventricular failure

Abstract

Sympathetic system stimulation, followed by activation of the renin, angiotensin, and aldosterone system, is an important contributor to the vicious circle of chronic heart failure (CHF). Accounting for this excessive neurohormonal response resulted in major and highly effective changes in therapeutic approach to CHF, primarily due to left ventricular (LV) dysfunction. Indeed, this disturbed neurohormonal balance can be at least partly restored by adrenergic beta-receptor blockers, angiotensin-conversion inhibitors and receptor blockers, and aldosterone antagonists, with beneficial functional and prognostic effects. Right ventricular (RV) dysfunction due to severe pulmonary hypertension (PH) ultimately results in similar changes in systemic haemodynamics, which trigger neurohormonal response in LV failure, including low cardiac index and hypotension. However, the evidence related to the presence and clinical significance of neurohormonal activation in primarily RV failure is very limited. Are similar neurohormonal mechanisms contributing to vicious circle of RV failure induced by PH? Could experience gained from left heart failure treatment be useful to protect RV? This somewhat provocative article will review the existing evidence, current recommendations, and future directions related to these problems.