Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension

Abstract

Cambios agudos en la función auricular derecha post uso de iloprost inhalatorio en pacientes con hipertensión arterial pulmonar: estudio con técnicas de deformación de imagen Recibido el 29 de junio de 2015 / Aceptado 30 de julio de 2015 Introducción: El efecto de prostanoides inhalato-rios sobre la función auricular derecha (AD) en hiper-tensión arterial idiopática (HAP) no ha sido estudiado. Objetivo: Evaluar cambios agudos en la función AD y función diastólica del ventrículo derecho en pacientes con HAP post uso de Iloprost inhalatorio. Métodos: Se incluyeron pacientes con HAP sin uso previo de prostanoides. Se realizó un ecocardiograma transtorácico basal y 30 min posterior a la inhalación de iloprost. Se midió dimensión AD, relación E/e´ye´y strain de la AD por speckle tracking, registrando la onda ne-gativa de contracción auricular (SaAD) y la onda posi-tiva de la fase de reservorio (SsAD). Se midió el tiempo de inicio de la fase de reservorio AD durante el sístole ventricular. Resultados: Se estudiaron 16 pacientes (15 muje-res), con edad promedio 44 ± 7,8 años. Post Iloprost disminuyó el volumen AD Conclusión: Con Iloprost inhalatorio en pacientes con HAP se observa una reducción aguda en el tama-ño de la AD y en las presiones de llenado del VD. La deformación durante la fase de reservorio de la AD au-menta y se inicia significativamente antes. Esto sugiere que el Iloprost podría mejorar en forma aguda el trabajo mecánico de la AD en paciente con HAP.

Right ventricular dyssynchrony and its improvements after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

“…(2) RV free wall activation was delayed compared to IVS and LV lateral wall indicating that there was interventricular dyssynchrony between RV and LV. Gabrielli et al19 showed the improvement of intraventricular dyssynchrony after iloprost therapy in patients with PAH.Why patients with COPD demonstrate delayed time to PLSS and intraventricular dyssynchrony remains unclear. (4) Time to PLSS difference between RV free wall and LV lateral wall was an independent predictor of hospitalization within 1 year.As far as to our knowledge, this is the first study that uses strain imaging to demonstrate RV delay compared to IVS and LV lateral wall and the effect of PRP on RV functions and interventricular dyssynchrony in patients with COPD.…”

“…A previous study with the use of magnetic resonance imaging myocardial tagging in patients with PAH has identified prolonged RV contraction as the cause of interventricular asynchrony 18. Gabrielli et al19 showed the improvement of intraventricular dyssynchrony after iloprost therapy in patients with PAH.Why patients with COPD demonstrate delayed time to PLSS and intraventricular dyssynchrony remains unclear. A possible explanation is that because of the RV pressure overload in patients with COPD, the contraction patterns in the RV are affected, leading to intra-and interventricular dyssynchrony, which has a negative effect on the TA B L E 2 The comparison of speckle tracking echocardiography indexes of chronic obstructive pulmonary disease patients before and after pulmonary rehabilitation program and healthy subjects…”

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

“…11,30,31 This derives mainly from delayed contraction of the basal and mid-RV free wall due to nonuniform distribution of wall stress in the dilated pressureloaded RV (Figure 3). 11,30,31 This derives mainly from delayed contraction of the basal and mid-RV free wall due to nonuniform distribution of wall stress in the dilated pressureloaded RV (Figure 3).…”

“…, PAH patients with normal RA size have significantly decreased RA reservoir function (RA normal: 37%±15% vs RA increased: 25%±10% vs controls: 57%±13%), whereas RA booster pump function remains preserved 54. Furthermore, 2DSTE-derived RA reservoir function values improve along with pulmonary hemodynamics 30 minute after PAH therapy application, while RA booster pump function remains unaffected 31. In a study with 82 PH patients, the worst outcome was for patients with RVFWLS <20% and total RA strain (of reservoir+conduit+pump function) <30.2% 56.…”

Drug development of Lung Diseases by way of Drug Repurposing; What a Pulmonary Physician can do in the Laboratory

“…It is very well known that for asthma and chronic obstructive disease (COPD) we use nebulisers, metered dose inhalers (MDIs), and dry powder inhalers (DPIs) for the delivery of inhalational bronchodilators and corticosteroids [1]. Moreover; there are inhaled antibiotics and inhaled drugs for pulmonary hypertension already on the market [2,3]. It is known that there are several factors affecting the distribution and absorption of an inhalational compound.…”