Changes in the radius of curvature of the ventricular septum at end diastole during pulmonary arterial and aortic constrictions in the dog.

Dong, Sheng-Jing; Smith, Eldon R.; Tyberg, John V.

doi:10.1161/01.cir.86.4.1280

Cited by 44 publications

(36 citation statements)

References 28 publications

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“…Despite similar wall thickness, diastolic stiffness in the RV of the banding group is higher by a factor of 2 than that of the normal LV. Although we do not have specific data regarding the septal geometry and geometry of the LV in terms of septal-to-free wall distance and apex-to-base distance, several studies indicate that as result of a chronic RV pressure overload (and thus decreased septal pressure gradient), the septum is displaced toward the LV (12,21). In addition, the septal-to-LV free wall distance is found to be decreased.…”

Section: Discussionmentioning

confidence: 73%

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: Discussionmentioning

confidence: 73%

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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“…Other possible mechanisms may include impaired left ventricular filling in the setting of right ventricular dysfunction, thereby contributing to higher rates of decompensated HF perioperatively, as seen in this study. This phenomenon is a consequence of prolonged contraction of the right ventricular free wall seen with right ventricular pressure overload, thus exceeding left ventricular pressures in early diastole and resulting in paradoxical septal movement leading to reduced left ventricular end-diastolic filling [21, 22]. The association between PH and perioperative MACEs after KT demonstrated in this analysis warrants future studies to better delineate potential mechanisms underlying these observations.…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Mortality and Major Adverse Cardiovascular Events after Kidney Transplantation in the United States

et al. 2018

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Background: Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease. Cardiovascular disease is a major determinant of morbidity and mortality in patients with KT. Temporal trends in perioperative cardiovascular outcomes after KT are understudied, especially in light of an aging KT waitlist population. Methods: We performed a retrospective observational cohort study using the National Inpatient Sample for the years 2004–2013. All adult patients undergoing KT were identified using the appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. Demographic and hospital characteristics, discharge disposition, payer status, and major adverse cardiovascular events (MACEs) were summarized using summary statistics. Multivariate logistic regression was used to identify predictors of MACEs in the perioperative period of KT. Results: A total of 147,431 KTs were performed between 2004 and 2013. The mean age at KT went up from 48.1 to 51.8 years from 2004 to 2013. Medicare was the primary payer for 59.6% of the KTs. Overall average perioperative mortality was 0.5%, median length of stay was 5 days, and 6.5% of patients experienced an MACE, 78% of which were heart failures (HFs). Important predictors of perioperative MACEs were age ≥65 years (OR = 2.14), Medicare as primary payer (OR = 1.51), diabetes (OR = 1.46), recreational drug use (OR = 1.72), pulmonary circulation disorders (OR = 3.28), and malnutrition (OR = 1.91). Conclusion: Despite increases in age at the time of KT, the absolute risk of perioperative MACEs has remained stable from 2004 to 2013. HF is a major component of postoperative MACEs in KT. Malnutrition and pulmonary hypertension are major nontraditional predictors of perioperative MACE outcomes.

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“…Dr Heresi: contributed to the study design, interpretation of data, and writing and revision of the manuscript. pressure gradient, 15,16 leading to decrease in LV compliance. 1,2,14,[17][18][19] Other causes include an increase in RV tension that leads to prolonged RV myocardial shortening with abnormal relaxation of the interventricular septum that impairs RV systole and LV diastole, 1,20 decrease in LV torsion, 21 delay in early diastolic LV untwisting, 22 reduction in the preload, 4,5,21 diastolic asynchrony in the anterior-lateral or apical regions, 23,24 and intrinsic disease of the left ventricle.…”

Section: Acknowledgmentsmentioning

confidence: 99%

Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

Tonelli¹,

Plana

Heresi³

et al. 2012

Chest

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Background:Little is known about the association between left ventricular (LV) diastolic dysfunction and outcomes in patients with idiopathic or heritable pulmonary arterial hypertension (PAH). Our rationale was to investigate the prevalence of LV diastolic dysfunction, and its association with disease severity and outcomes, in patients with idiopathic or heritable PAH. Methods: Using the Cleveland Clinic Pulmonary Hypertension Registry, we identifi ed subjects with heritable or idiopathic PAH who underwent Doppler echocardiography and right-sided heart catheterization. Echocardiographic diastolic parameters were assessed in each patient. Results: A total of 61 patients met the inclusion criteria (idiopathic 85%, heritable 15%). The age at the time of echocardiography was 48.3 Ϯ 18 years, 84% of the subjects were women, and 48% were on PAH-targeted therapies. Normal LV diastolic function, impaired relaxation, and pseudonormalization were seen in 10%, 88%, and 2% of the patients, respectively. Peak early diastolic (peak E) velocity was directly associated with LV end-diastolic volume and cardiac index and inversely associated with the degree of right ventricular dilation, right atrial pressure, and pulmonary vascular resistance. Peak E velocity was associated with mortality adjusted for age and sex (hazard ratio [HR], 1.5; 95% CI, 1.1-2 per 10 cm/s decrease; P 5 .015) and age, sex, 6-min walk distance, and cardiac output (HR, 1.8; 95% CI, 1.2-2.9 per 10 cm/s decrease; P 5 .01). Conclusions: LV diastolic dysfunction of the impaired relaxation type is observed in the majority of patients with advanced idiopathic or heritable PAH. A decrease in transmitral fl ow peak E velocity is associated with worse hemodynamics and outcome. CHEST 2012; 141(6):1457-1465Abbreviations: A 5 late diastolic; D 5 anterograde diastolic; E 5 early diastolic; HR 5 hazard ratio; LA 5 left atrial; LV 5 left ventricular; NYHA 5 New York Heart Association; PAH 5 pulmonary arterial hypertension; PAOP 5 pulmonary artery occlusion pressure; PAP 5 pulmonary artery pressure; PVR 5 pulmonary vascular resistance; RA 5 right atrial; RHC 5 right-sided heart catheterization; RV 5 right ventricular; S 5 systolic

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Changes in the radius of curvature of the ventricular septum at end diastole during pulmonary arterial and aortic constrictions in the dog.

Abstract: Background. At end diastole, the position and shape of the ventricular septum depend on the transseptal pressure gradient. It is not clear, however, how the septal radius of curvature changes in response to the

Cited by 44 publications

References 28 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

In-Hospital Mortality and Major Adverse Cardiovascular Events after Kidney Transplantation in the United States

Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

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