{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:06:34Z","timestamp":1784261194573,"version":"3.55.0"},"reference-count":57,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Chronic right heart failure (RHF) is a complex, progressive syndrome that remains underrecognized and inadequately defined in current clinical guidelines, where it is often relegated to a secondary complication of left-sided heart disease. Because the thin-walled right ventricle (RV) is well adapted to maintain pressures within the highly distensible venous system well below plasma oncotic pressure but poorly equipped to sustain pressure overload, when myocardial failure supervenes, conventional RV systolic indices frequently fail to capture the very essence of the syndrome. This review clarifies the distinct pathophysiological and haemodynamic foundations of chronic RHF, framing it fundamentally as the heart\u2019s inability to decongest the systemic venous circulation. We highlight how backward failure, rather than isolated RV systolic dysfunction, drives systemic and multi-organ congestion. To bridge existing diagnostic gaps, we propose a pragmatic, diagnostic algorithm. Under this framework, a Definite Diagnosis of chronic RHF requires evidence of elevated right atrial\/central venous pressures\u2014defined as clinically raised jugular venous pressure plus an echocardiographic dilated inferior vena cava (&gt;21 mm with &lt;50% collapse)\u2014alongside at least one of four minor criteria: (1) systemic or visceral congestion (e.g., persistent oedema, congestive hepatomegaly); (2) echocardiographic RV systolic dysfunction (TAPSE &lt; 17 mm, FAC &lt; 35%, S\u2032 &lt; 9.5 m\/s; RV free-wall strain &gt; \u221220%); (3) non-invasive signs of pulmonary hypertension (TRV &gt; 2.8 m\/s); or (4) impaired RV-pulmonary arterial coupling (TAPSE\/PASP ratio &lt; 0.35). By centering diagnosis on systemic venous hypertension as a result of right heart backward failure rather than isolated RV metrics, this framework offers a coherent, readily applicable tool for diagnosing chronic RHF in routine clinical practice.<\/jats:p>","DOI":"10.3390\/jcdd13070317","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Right Heart Failure: Pathogenesis, Haemodynamic Foundations, and a Pragmatic Diagnostic Algorithm"],"prefix":"10.3390","volume":"13","author":[{"given":"Frank Lloyd","family":"Dini","sequence":"first","affiliation":[{"name":"Auxologico: Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20149 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6235-984X","authenticated-orcid":false,"given":"Alberto","family":"Palazzuoli","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, AOUS, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9296-4397","authenticated-orcid":false,"given":"Erberto","family":"Carluccio","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiovascular Pathophysiology, University Hospital S. Maria della Misericordia of Perugia, Piazzale Menghini 1, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Genova, 16126 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2379-1960","authenticated-orcid":false,"given":"Michele","family":"Ciccarelli","sequence":"additional","affiliation":[{"name":"Departmentof Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Mercurio","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Ruocco","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cI. Veris Delli Ponti\u201d Hospital, ASL Lecce, 73020 Scorrano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2352-2103","authenticated-orcid":false,"given":"Andrea","family":"Salzano","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7863-253X","authenticated-orcid":false,"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Ghio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Paolillo","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-1735","authenticated-orcid":false,"given":"Savina","family":"Nodari","sequence":"additional","affiliation":[{"name":"Cardiology Section, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-8478","authenticated-orcid":false,"given":"Gianfranco","family":"Sinagra","sequence":"additional","affiliation":[{"name":"Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e578","DOI":"10.1161\/CIR.0000000000000560","article-title":"Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement from the American Heart Association","volume":"137","author":"Konstam","year":"2018","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Walsh, M.N., Kober, L., Sliwa, K., Adamo, M., Agarwal, A., Banerjee, A., Bozkurt, B., Cikes, M., Damasceno, A., and Desai, A.S. 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