Although long neglected, the right side of the heart (RH) is now widely accepted as a pivotal player in heart failure (HF) either with reduced or preserved ejection fraction. The chronic overload of the pulmonary microcirculation results in an initial phase characterized by right ventricular (RV) hypertrophy, right atrial dilation, and diastolic dysfunction. This progresses to overt RH failure when RV dilation and systolic dysfunction lead to RV-pulmonary arterial (RV-PA) uncoupling with low RV output. In the context of its established relevance to progression of HF, clinicians should consider assessment of the RH with information from clinical assessment, biomarkers, and imaging. Notably, no single parameter can predict prognosis alone in HF. Assessments simultaneously should encompass RV systolic function, pulmonary pressures, an estimation of RV-PA coupling, and RH morphologic features. Despite a large volume of evidence indicating the relevance of RH function to the clinical syndrome of HF, evidence-based management strategies are lacking. Targeting RH dysfunction in HF should be an objective of future investigations, being an unmet need in the current management of HF.

虽然长期以来一直被忽视，但心脏右侧 (RH) 现在被广泛认为是射血分数降低或保留的心力衰竭 (HF) 的关键因素。肺微循环的慢性超负荷导致以右心室 (RV) 肥大、右心房扩张和舒张功能障碍为特征的初始阶段。当 RV 扩张和收缩功能障碍导致 RV-肺动脉 (RV-PA) 与低 RV 输出脱钩时，这会发展为明显的 RH 衰竭。在确定其与 HF 进展相关的背景下，临床医生应考虑使用来自临床评估、生物标志物和影像学的信息来评估 RH。值得注意的是，没有一个参数可以单独预测 HF 的预后。同时评估应包括 RV 收缩功能、肺压、RV-PA 耦合和 RH 形态特征的估计。尽管有大量证据表明 RH 功能与 HF 临床综合征相关，但仍缺乏基于证据的管理策略。针对 HF 中的 RH 功能障碍应该是未来研究的目标，这是当前 HF 管理中未满足的需求。