Shedding Light on the Dark Side of the Moon—Understanding Pediatric Right Ventricular Work in Pulmonary Hypertension

Although right ventricle (RV) dysfunction drives clinical worsening in pulmonary hypertension (PH), information about RV function has not been well integrated in PH risk assessment. The gold standard for assessing RV function and ventriculo-arterial coupling is the construction of multi-beat pressure–volume (PV) loops.

In the study “Echocardiographic grading of right ventricular afterload in left heart disease: relation to right ventricular function, pulsatile and resistant load, and outcome,” Bech-Hanssen et al. addressed an interesting topic about severity gradation using right ventricular (RV) afterload echocardiographic assessment.

Increased pulmonary artery systolic pressure (PASP) with downstream consequences on the right ventricle (RV) is the shared hallmark of the various forms of pulmonary hypertension (PH). The underlying pathophysiology of elevated PASP varies greatly between PH classification groups.

The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance.