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The differentiation of adaptive versus maladaptive RVH is imprecise, but adaptive RVH is associated with better functional capacity and survival. At the molecular level, maladaptive RVH displays greater impairment of angiogenesis, adrenergic signaling, and metabolism than adaptive RVH, and these derangements often involve the left ventricle. Clinically, maladaptive RVH is characterized by increased N-terminal pro\u2013brain natriuretic peptide levels, troponin release, elevated catecholamine levels, RV dilatation, and late gadolinium enhancement on MRI, increased\n                    <jats:sup>18<\/jats:sup>\n                    fluorodeoxyglucose uptake on positron emission tomography, and QTc prolongation on the ECG. In maladaptive RVH there is reduced inotrope responsiveness because of G-protein receptor kinase\u2013mediated downregulation, desensitization, and uncoupling of \u03b2-adrenoreceptors. RV ischemia may result from capillary rarefaction or decreased right coronary artery perfusion pressure. Maladaptive RVH shares metabolic abnormalities with cancer including aerobic glycolysis (resulting from a forkhead box protein O1\u2013mediated transcriptional upregulation of pyruvate dehydrogenase kinase), and glutaminolysis (reflecting ischemia-induced cMyc activation). Augmentation of glucose oxidation is beneficial in experimental RVH and can be achieved by inhibition of pyruvate dehydrogenase kinase, fatty acid oxidation, or glutaminolysis. Therapeutic targets in RV failure include chamber-specific abnormalities of metabolism, angiogenesis, adrenergic signaling, and phosphodiesterase-5 expression. The ability to restore RV function in experimental models challenges the dogma that RV failure is irreversible without regression of pulmonary vascular disease.\n                  <\/jats:p>","DOI":"10.1161\/circresaha.113.301129","type":"journal-article","created":{"date-parts":[[2014,6,20]],"date-time":"2014-06-20T10:52:25Z","timestamp":1403261545000},"page":"176-188","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":450,"title":["The Right Ventricle in Pulmonary Arterial Hypertension"],"prefix":"10.1161","volume":"115","author":[{"given":"John J.","family":"Ryan","sequence":"first","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City (J.J.R.); and Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada (S.L.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Archer","sequence":"additional","affiliation":[{"name":"From the Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City (J.J.R.); and Department of Medicine, Queen\u2019s University, Kingston, Ontario, Canada (S.L.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/35025190"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-381510-1.00038-7"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1242\/dev.01256"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)01437-5"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e3181c7671c"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200604-547OC"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(84)90321-1"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1522-2586(199912)10:6<908::AID-JMRI2>3.0.CO;2-2"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.2.502"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.110.985515"},{"key":"e_1_3_5_12_2","first-page":"629","article-title":"Ventricular performance following ablation and prosthetic replacement of right ventricular myocardium.","volume":"20","author":"Sawatani S","year":"1974","unstructured":"Sawatani S, Mandell G, Kusaba E, Schraut W, Cascade P, Wajszczuk WJ, Kantrowitz A. 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