{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:09:20Z","timestamp":1792843760084,"version":"4.5.0"},"reference-count":172,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"publisher","award":["SFB 1213"],"award-info":[{"award-number":["SFB 1213"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The contribution of the right ventricle (RV) to cardiac output is negligible in normal resting conditions when pressures in the pulmonary circulation are low. However, the RV becomes relevant in healthy subjects during exercise and definitely so in patients with increased pulmonary artery pressures both at rest and during exercise. The adaptation of RV function to loading rests basically on an increased contractility. This is assessed by RV end-systolic elastance (Ees) to match afterload assessed by arterial elastance (Ea). The system has reserve as the Ees\/Ea ratio or its imaging surrogate ejection fraction has to decrease by more than half, before the RV undergoes an increase in dimensions with eventual increase in filling pressures and systemic congestion. RV-arterial uncoupling is accompanied by an increase in diastolic elastance. Measurements of RV systolic function but also of diastolic function predict outcome in any cause pulmonary hypertension and heart failure with or without preserved left ventricular ejection fraction. Pathobiological changes in the overloaded RV include a combination of myocardial fibre hypertrophy, fibrosis and capillary rarefaction, a titin phosphorylation-related displacement of myofibril tension\u2013length relationships to higher pressures, a metabolic shift from mitochondrial free fatty acid oxidation to cytoplasmic glycolysis, toxic lipid accumulation, and activation of apoptotic and inflammatory signalling pathways. Treatment of RV failure rests on the relief of excessive loading.<\/jats:p>","DOI":"10.1093\/cvr\/cvad108","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T21:28:40Z","timestamp":1689715720000},"page":"1891-1904","source":"Crossref","is-referenced-by-count":45,"title":["Pathophysiology of the right ventricle in health and disease: an update"],"prefix":"10.1093","volume":"119","author":[{"given":"Khodr","family":"Tello","sequence":"first","affiliation":[{"name":"Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC) , Klinikstrasse 36, 35392 Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Naeije","sequence":"additional","affiliation":[{"name":"Pathophysiology, Faculty of Medicine, Free University of Brussels , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"de Man","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Amsterdam Medical Center , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Guazzi","sequence":"additional","affiliation":[{"name":"Cardiology Division, San Paolo University Hospital, University of Milano , Milano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"2023081913262170500_cvad108-B1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0002-8703(43)90325-4","article-title":"The absence of conspicuous increments of venous pressure after severe damage to the right ventricle of the dog, with a discussion of the relation between clinical congestive failure and heart disease","volume":"26","author":"Starr","year":"1943","journal-title":"Am Heart J"},{"key":"2023081913262170500_cvad108-B2","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/thx.26.3.240","article-title":"Surgical repair of tricuspid atresia","volume":"26","author":"Fontan","year":"1971","journal-title":"Thorax"},{"key":"2023081913262170500_cvad108-B3","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1136\/hrt.2004.051789","article-title":"The Fontan circulation","volume":"91","author":"Gewillig","year":"2005","journal-title":"Heart"},{"key":"2023081913262170500_cvad108-B4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jacc.2008.02.081","article-title":"Pediatric Heart Network Investigators","volume":"52","author":"Paridon","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2023081913262170500_cvad108-B5","doi-asserted-by":"crossref","first-page":"R171","DOI":"10.1152\/ajpregu.00444.2012","article-title":"The role of the fragility of the pulmonary blood-gas barrier in the evolution of the pulmonary circulation","volume":"304","author":"West","year":"2013","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"2023081913262170500_cvad108-B6","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1161\/01.RES.2.4.326","article-title":"The limits of right ventricular compensation following acute increase in pulmonary circulatory resistance","volume":"2","author":"Guyton","year":"1054","journal-title":"Circ Res"},{"key":"2023081913262170500_cvad108-B7","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1113\/jphysiol.1914.sp001676","article-title":"The regulation of the heartbeat","volume":"48","author":"Patterson","year":"1914","journal-title":"J Physiol"},{"key":"2023081913262170500_cvad108-B8","first-page":"358","article-title":"The adaptation of ventricular muscle to different circulatory conditions","volume":"67","author":"Rosenblueth","year":"1959","journal-title":"Arch Int Physiol Biochim"},{"key":"2023081913262170500_cvad108-B9","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1161\/CIRCULATIONAHA.113.001375","article-title":"Right versus left ventricular failure. 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