4. Physicians need to be mindful to protect the right ventricle of patients with HFpEF.
Both pulmonary hypertension and RV dysfunction are highly prevalent in HFpEF. RV dysfunction probably results from a combination of impaired RV contractile function and elevated RV afterload. Longitudinal HFpEF studies have shown that RV structure and function worsen over time; this deterioration has been associated with atrial fibrillation, coronary artery disease, obesity, and increased left heart and pulmonary venous pressures.
As left heart filling pressures rise, the pulmonary vasculature becomes less compliant, increasing RV afterload. In addition, remodeling of the pulmonary vasculature, including intimal thickening in the veins and intimal and medial thickening in the arteries, may occur. Therefore, tailored diuretic therapy to normalize left heart filling pressures and prevent pulmonary congestion is a mainstay of treatment for patients with HFpEF. Discharge diuretics were recently associated with both a reduction in 30-day HF rehospitalizations and