Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance

Brookes, Carl; Ravn, Hanne Berg; White, Paul A.; Moeldrup, U.; Oldershaw, Paul; Redington, Andrew N.

doi:10.1161/01.cir.100.7.761

Cited by 148 publications

(78 citation statements)

References 14 publications

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“…Pressure-conductance catheters (5-Fr; Millar Instruments, Houston, TX) were positioned in both ventricles for continuous and simultaneous measurement of LV and RV pressures and volumes (3,11,29). The LV catheter was introduced via a minor stab wound in the LV apex and positioned along the long axis of the LV.…”

Section: Methodsmentioning

confidence: 99%

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Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

Leeuwenburgh

Steendijk²,

Helbing

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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. Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs. Am J Physiol Heart Circ Physiol 282: H1350-H1358, 2002. First published December 13, 2001; 10.1152/ajpheart.00782.2001.-Diastolic function is a major determinant of ventricular performance, especially when loading conditions are altered. We evaluated biventricular diastolic function in lambs and studied possible load dependence of diastolic parameters [minimum first derivative of pressure vs. time (dP/dt min) and time constant of isovolumic relaxation ()] in normal (n ϭ 5) and chronic right ventricular (RV) pressure-overloaded (n ϭ 5) hearts by using an adjustable band on the pulmonary artery (PAB). Pressure-volume relations were measured during preload reduction to obtain the end-diastolic pressure-volume relationship (EDPVR). In normal lambs, absolute dP/dt min and were lower in the RV than in the left ventricle whereas the chamber stiffness constant (b) was roughly the same. After PAB, RV and dP/dt min were significantly higher compared with control. The RV EDPVR indicated impaired diastolic function. During acute pressure reduction, both dP/dt min and showed a relationship with end-systolic pressure. These relationships could explain the increased dP/dt min but not the increased -value after banding. Therefore, the increased after banding reflects intrinsic myocardial changes. We conclude that after chronic RV pressure overload, RV early relaxation is prolonged and diastolic stiffness is increased, both indicative of impaired diastolic function.hemodynamics; hypertrophy; pressure-volume relation; ventricular function, diastole THE IMPORTANCE of diastolic function as a major determinant of ventricular performance has long been recognized. Impaired diastolic function may precede systolic ventricular dysfunction (13,14), and it influences the performance of the contralateral ventricle via ventricular interdependence (23,34,39). The gold standard for determination of right ventricular (RV) [and left ventricular (LV)] diastolic function is still considered to be cardiac catheterization with simultaneous high-fidelity pressure and volume measurements (32).Because RV cineangiography is only sporadically performed during routine diagnostic catheterization and because complex RV geometry hampers adequate RV volume determination, few data are available about RV diastolic function. With the combined pressureconductance catheter it has recently become possible to determine ventricular pressure and volume simultaneously and independently of ventricular geometry in the LV as well as in the RV (3,11).Using this method, we are able to determine parameters of diastolic function such as the end-diastolic pressure-volume relationship (EDPVR) and chamber stiffness constant (b) that are well accepted for LV diastolic analysis. Furthermore, some of the LV relaxation parameters have shown a relationship with load (systolic pressure) that may render them less reliable to characterize intrinsic diastolic properties (26, 33)...

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Section: Methodsmentioning

confidence: 99%

“…With the combined pressureconductance catheter it has recently become possible to determine ventricular pressure and volume simultaneously and independently of ventricular geometry in the LV as well as in the RV (3,11).…”

mentioning

confidence: 99%

Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

Leeuwenburgh

Steendijk²,

Helbing

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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“…First, the pericardium was opened in the model, which may decrease the effects of ventricular interdependence [32]. In fact, the adverse effects of RV enlargement on left ventricular function have been demonstrated to be significantly lower when the pericardium is open.…”

Section: Study Limitationsmentioning

confidence: 99%

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

et al. 2014

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Right ventricular (RV) response to exercise or pharmacological stress is not well documented in pulmonary hypertension (PH). We investigated the relationship between RV reserve and ventricular-arterial coupling.Surgical ligation of the left pulmonary artery was performed in 13 Large White piglets (PH group), thereafter weekly embolisations of the right lower lobe were performed for 5 weeks. A control group of six piglets underwent sham procedures. Right heart catheterisation and echocardiography were performed at week 6. Pressure-volume loops were recorded before and after dobutamine infusion.Induction of experimental PH resulted in a higher mean±SD pulmonary artery pressure (34±9 versus 14±2 mmHg; p<0.01) and in a lower ventricular-arterial coupling efficiency (0.66±0.18 versus 1.24±0.17; p<0.01) compared with controls at 6 weeks. Dobutamine-induced relative changes in RV stroke volume index (SVI) and end-systolic elastance were lower in the PH group (mean±SD 47±5% versus 20±5%, p<0.01, and 81±37% versus 32±14%, p<0.01, respectively). Change in SVI was strongly associated with resting ventricular-arterial coupling (R 2 =0.74; p<0.01). RV reserve was associated with ventricular-arterial coupling in a porcine model of chronic pressure overload. @ERSpublications Dobutamine testing in right ventricular pressure overload: a potentially useful method to assess contractile reserve

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“…This alteration in geometry also impairs LV systolic function. 27 Therefore, the common practice of aggressive fluid resuscitation for RV dysfunction in shock may be misguided. Inotropic therapy is indicated for RV failure when CS persists after RV end-diastolic pressure has been optimized.…”

Section: Right Ventriclementioning

confidence: 99%

Cardiogenic Shock

2008

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ardiogenic shock (CS) occurs in Ϸ5% to 8% of patients hospitalized with ST-elevation myocardial infarction (STEMI). Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of CS. Early revascularization for CS improves survival substantially. New mechanical approaches to treatment are available, and clinical trials are feasible even in this high-risk population. Most importantly, hospital survivors have an excellent chance for long-term survival with good quality of life. This review will outline the causes, pathophysiology, and treatment of CS with a focus on CS complicating myocardial infarction (MI.) The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. The diagnosis is usually made with the help of pulmonary artery (PA) catheterization; however, Doppler echocardiography may also be used to confirm elevation of LV filling pressures. 1 Hypoperfusion may be manifest clinically by cool extremities, decreased urine output, and/or alteration in mental status. Hemodynamic abnormalities form a spectrum that ranges from mild hypoperfusion to profound shock, and the short-term outcome is directly related to the severity of hemodynamic derangement. MI with LV failure remains the most common cause of CS. It is critical to exclude complicating factors that may cause shock in MI patients. Chief among these are the mechanical complications: ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical complications must be strongly suspected in patients with CS complicating nonanterior MI, particularly a first MI. Echocardiography is the technique of choice to rule out these entities and should be performed early unless the diagnosis is extensive anterior MI and the patient is undergoing prompt percutaneous coronary intervention (PCI). In addition, the detection of valvular disease before angiography may alter the revascularization approach. Diagnosis and CausesHemorrhage, infection, and/or bowel ischemia may contribute to shock in the setting of MI. As with mechanical complications, a high index of suspicion is required to make these diagnoses in MI patients, and survival may depend on timely recognition and treatment.Any cause of acute, severe LV or RV dysfunction may lead to CS. Acute myopericarditis, tako-tsubo cardiomyopathy, and hypertrophic cardiomyopathy may all present with ST elevation, release of cardiac markers, and shock in the absence of significant coronary artery disease. Stress-induced cardiomyopathy, also known as apical ballooning or takotsubo cardiomyopathy, is a syndrome of acute LV dysfunction after emotional or respiratory distress that leads to CS in 4.2% of cases. 2 Acute valvular regurgitation, typically caused by endocarditis or chordal rupture due to trauma or degenerative disease, may also cause CS. Aortic dissection may lead to CS via acute,...

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Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance

Abstract: The hemodynamic compromise seen in association with acute RV dilatation within an intact pericardium is partly attributable to impaired LV systolic performance and cannot be wholly ascribed to changes in LV preload or compliance.

Cited by 148 publications

References 14 publications

Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

Cardiogenic Shock

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