Utilising biomarkers to predict right heart maladaptive phenotype: a step toward precision medicine

Pulmonary hypertension (PH) is associated with pressure overload of the right ventricle (RV), which initially provokes adaptive RV changes, such as increased wall thickness and contractility [1] In this regard, adaptive RV hypertrophy is characterised by preserved cardiac output, maintained RV ejection fraction, and, as a consequence, largely maintained exercise capacity. In some patients, or in the later course of the disease, however, persistently increased afterload results in maladaptive, pathological remodelling processes, RV uncoupling, and right heart failure. These changes are associated with worse outcomes [1] and, importantly, RV failure is one of the strongest predictors of mortality in PH. Moreover, left heart diseases, considered as major causes of PH, may also be associated with RV remodelling/dysfunction, adversely affecting outcomes in these patient populations [2–5]. Hence, it is important to develop diagnostic tools and, in particular, biomarkers that are able to discriminate left ventricular from right ventricular hypertrophy/failure, to assess RV disease severity and detect early maladaptive changes in RV size, function and structure [1]. There is now growing evidence that such biomarkers may be identified.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research