The ATS has published an official research statement on right ventricular (RV) function that reviews current knowledge of RV failure, identifies research priorities, and recommends strategies for closing those knowledge gaps.

Eighteen members of the ATS Pulmonary Circulation and Critical Care Assemblies, along with two outside experts, collaborated in writing “Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward,” published in the Aug. 15 American Journal of Respiratory and Critical Care Medicine.

According to the authors, RV function is the most important “prognostic determinant of survival in pulmonary hypertension (PH),” and estimates indicate that 70 million people in the United States have abnormal RV function.

Although considerable progress has been made in understanding RV adaption and maladaptation in PH since the National Institutes of Health convened a panel of experts in 2005, the authors write that gaps in understanding the cellular and molecular mechanisms of “RV responses to pressure and volume overload” and in validating diagnostic modalities present barriers to developing therapies.

“In the short term, we hope this statement will facilitate RV research by asking new questions and challenging the questions already being asked,” said lead author Tim Lahm, MD, associate professor of medicine at the Indiana University School of Medicine. “This, in turn, should lead to novel approaches, new collaborations, and increased research funding.”

The authors organized their statement around three topics:

• Optimizing the methodology to assess RV function in acute and chronic conditions in pre-clinical models, human studies, and clinical trials. The authors argue that there is a need to study RV structure and function in health, as well as the many trajectories RV failure takes. This knowledge may enable clinicians to target RV abnormalities before symptoms develop.
• Analyzing advanced RV hemodynamic parameters at rest and in response to exercise. The authors write that RV failure phenotyping and prognostication require greater understanding of the strengths and weaknesses of the currently used diagnostic tools, which will, among other approaches, require multicenter trials.
• Deciphering the underlying molecular and pathogenic mechanisms of RV function and failure in diverse PH syndromes. To achieve this, the authors said, research is necessary to understand the association between development of RV hypertrophy and failure and processes such as angiogenesis, fibrosis, cardiomyocyte metabolism, cell death, inflammation, oxidative stress, contractile signaling and calcium handling.

The authors conclude their statement by noting that advances in integrative basic, translational, and clinical RV research are necessary to “prevent or reverse the progression from adaptive to maladaptive RV modeling” of any etiology. 

Dr. Lahm said the creativity, energy, and collaborative spirit of the interdisciplinary panel of experts was noteworthy.  He added that he and his colleagues are convinced that this research statement will facilitate new knowledge about RV phenotypes and function in health and disease, foster new diagnostic approaches, and generate new treatment strategies.

“Ultimately, the knowledge gained would be expected to translate into better outcomes for patients,” he said.