Overview
Acute right-sided heart failure (RHF) involves dysfunction of the right ventricle, often secondary to conditions like severe tricuspid regurgitation (TR) and pulmonary hypertension, leading to symptoms such as peripheral edema, ascites, and hepatomegaly. 12Diagnosis
Key Diagnostic Criteria: Presence of severe TR, signs of right ventricular dysfunction, and clinical symptoms like peripheral edema and ascites.
Recommended Tests:
- Echocardiography for assessing TR severity and right ventricular function.
- Contrast-enhanced CT to detect retrograde inferior vena cava or hepatic vein opacification, indicative of right-sided heart disease. 2
Grading: TR severity graded using echocardiography; right ventricular dysfunction assessed via end-diastolic and end-systolic dimensions. 1Management
First-Line Treatments:
- Tricuspid Valve Interventions: Transcatheter edge-to-edge repair (T-TEER), tricuspid valve annuloplasty, and transcatheter tricuspid valve replacement (TTVR).
- Medical Management: Diuretics for decongestion, management of underlying causes (e.g., atrial fibrillation, pulmonary hypertension).
Adjunctive Treatments:
- Optimization of preload and afterload through careful fluid management and vasodilators if indicated.
- Monitoring and management of residual TR post-intervention to ensure right ventricular reverse remodeling (RVRR). 1Special Populations
Comorbidities: Pulmonary hypertension and tricuspid regurgitation significantly influence diagnostic accuracy via contrast-enhanced CT findings. 2
No specific guidance provided for pregnancy, pediatrics, or elderly populations based on the given abstracts.Key Recommendations
Evaluate residual tricuspid regurgitation post-intervention as residual TR ≤1+ is associated with pronounced right ventricular reverse remodeling, improving clinical outcomes. (Evidence: Moderate) 1
Utilize contrast-enhanced CT with careful consideration of contrast injection rates to accurately identify retrograde inferior vena cava or hepatic vein opacification, indicative of right-sided heart disease. (Evidence: Moderate) 2
Prioritize tricuspid valve interventions (T-TEER, annuloplasty, TTVR) in patients with severe TR and right-sided heart failure to achieve significant RVRR and potentially improve survival. (Evidence: Moderate) 1References
1 Weckbach LT, Stolz L, Doldi PM, Glaser H, Ennin C, Kothieringer M et al.. Relevance of residual tricuspid regurgitation for right ventricular reverse remodelling after tricuspid valve intervention in patients with severe tricuspid regurgitation and right-sided heart failure. European journal of heart failure 2025. link
2 Yeh BM, Kurzman P, Foster E, Qayyum A, Joe B, Coakley F. Clinical relevance of retrograde inferior vena cava or hepatic vein opacification during contrast-enhanced CT. AJR. American journal of roentgenology 2004. link