Fig. 4

The dynamic nature of RVD illustrated by a patient with ischemic cardiomyopathy. At baseline (upper panel) the patient had biventricular failure with at catheterization PCWP 30 mmHg, RVEDP 17 mmHg, SvO₂ 45% and NT-proBNP 5000 ng/L. The RVD score was 5 with moderate pulmonary hypertension, reduced TAPSE, RV dilatation, increased central venous pressure and severe tricuspid regurgitation. One week later (middle panel) after treatment with levosimendan and intravenous furosemide, NT-proBNP was 1080 ng/L and the RVD score was 1 due to reduced TAPSE. Six weeks later (lower panel), the patient was in NYHA class IIIb, NT-proBNP was 2370 and the RVD score 3. The hemodynamic profile from the RVD score indicated at baseline that the patient was wet-cold, one week later dry-warm or wet-warm and after 6 weeks wet-cold or wet-warm