Multiscale Mechanobiology of Right Ventricular Failure

The pumping functions of the right and left ventricles are inseparably linked. The right ventricle (RV) performs mechanical work both in pumping blood through the pulmonary circulation and in driving preload to the left ventricle (LV). This functional coupling is particularly apparent in exercise, as recruitment of increased LV power output relies on commensurate increases in pulmonary venous pressure, which are driven by increased RV work[1]. Indeed, while human cardiac power output may increase four-fold from rest to maximal exercise in the LV, the dynamic range of RV power output is approximately six-fold, because pulmonary pressures increase relatively more than systemic pressures in exercise[2]. Similarly, LV failure is compensated for by elevated pulmonary pressures and RV work. Chronically elevated RV work, whether due to LV dysfunction or pulmonary arterial hypertension, leads to RV failure (RVF). Unfortunately, the etiology of RVF is much less studied than that of LV failure with the consequence that no targeted therapies for RVF exist.