Molecular mechanisms of right ventricular dysfunction in pulmonary arterial hypertension: focus on the coronary vasculature, sex hormones, and glucose/lipid metabolism
| Autor: | Vineet Agrawal, Georg Hansmann, Anna R. Hemnes, Tim Lahm |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Angiogenesis business.industry Prostacyclin Lipid metabolism 030204 cardiovascular system & hematology Review Article on Right Ventricular Dysfunction Pathogenesis 03 medical and health sciences 0302 clinical medicine Pharmacotherapy medicine.anatomical_structure 030228 respiratory system Internal medicine Cardiology medicine Vascular resistance Etiology Cardiology and Cardiovascular Medicine business medicine.drug Hormone |
| Zdroj: | Cardiovasc Diagn Ther |
| ISSN: | 2223-3660 2223-3652 |
| DOI: | 10.21037/cdt-20-404 |
| Popis: | Pulmonary arterial hypertension (PAH) is a rare, life-threatening condition characterized by dysregulated metabolism, pulmonary vascular remodeling, and loss of pulmonary vascular cross-sectional area due to a variety of etiologies. Right ventricular (RV) dysfunction in PAH is a critical mediator of both long-term morbidity and mortality. While combinatory oral pharmacotherapy and/or intravenous prostacyclin aimed at decreasing pulmonary vascular resistance (PVR) have improved clinical outcomes, there are currently no treatments that directly address RV failure in PAH. This is, in part, due to the incomplete understanding of the pathogenesis of RV dysfunction in PAH. The purpose of this review is to discuss the current understanding of key molecular mechanisms that cause, contribute and/or sustain RV dysfunction, with a special focus on pathways that either have led to or have the potential to lead to clinical therapeutic intervention. Specifically, this review discusses the mechanisms by which vessel loss and dysfunctional angiogenesis, sex hormones, and metabolic derangements in PAH directly contribute to RV dysfunction. Finally, this review discusses limitations and future areas of investigation that may lead to novel understanding and therapeutic interventions for RV dysfunction in PAH. |
| Databáze: | OpenAIRE |
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