Coronary flow reserve and oxygen metabolism of the right ventricle.

Saito, Daiji; Yamada, Nobuyuki; Kusachi, Shozou; Tani, Hideki; Shimizu, Akinori; Hina, Kazumasa; Watanabe, Hirofumi; Ueeda, Masayuki; Mima, Tsutomu; Tsuji, Takao; Haraoka, Shoichi

doi:10.1253/jcj.53.1310

Cited by 21 publications

(12 citation statements)

References 15 publications

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“…The blood flow ratio seems to be higher than the ratio of oxidative metabolism estimated in the present study, suggesting a lower oxygen extraction fraction in the RV. Experimental studies in the canine model showed a lower myocardial oxygen extraction at rest and a greater capacity for increase in oxygen utilization in association with myocardial demand in the RV [30,31]. Although maximum increase in the pressure-rate product was not achieved in the present study, the similar results of oxidative metabolism were observed in the human study in the moderate increase in cardiac work-load.…”

Section: Assessment Of R V Myocardiumsupporting

confidence: 63%

Oxidative metabolism in the myocardium in normal subjects during dobutamine infusion

et al. 1993

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To assess the biventricular response of the clearance rate of carbon-11 acetate as an index of myocardial oxidative metabolism to increase in work-load, dynamic positron emission tomography was performed at rest and during dobutamine infusion in 14 normal subjects. The clearance rate constant (Kmono) of the left ventricular (LV) myocardium increased during dobutamine infusion (0.112 +/- 0.020 min-1 vs 0.065 +/- 0.015 min-1 at rest) (P < 0.001) in proportion to the increase in the pressure-rate product. Kmono in the right ventricular (RV) myocardium also increased (0.080 +/- 0.018 min-1 vs 0.034 +/- 0.013 min-1 at rest) (P < 0.001), with an excellent correlation with the LV Kmono (r = 0.920). The fact that the increase in RV Kmono during dobutamine infusion was greater (158% +/- 81%) than that in LV Kmono (79% +/- 39%) (P < 0.005) indicates a greater increase in oxidative metabolism in the RV in response to inotropic stimulation in normal subjects.

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Section: Assessment Of R V Myocardiumsupporting

confidence: 63%

Oxidative metabolism in the myocardium in normal subjects during dobutamine infusion

et al. 1993

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“…In IPAH, the elevated afterload considerably increases the metabolic demand of the right heart. The high median baseline OEF of 0.73 in the present population of patients with IPAH reflects this increased O 2 demand and is consistent with previous open-chest animal studies using chronic RV overload induced by pulmonary artery banding with significantly higher O 2 extraction compared to control (58% vs 51%) 5 22…”

Section: Discussionsupporting

confidence: 90%

“…Other studies showed that the resting RV MBF or RCA flow in the chronically hypertrophied right myocardium was either unaltered5 22 23 or elevated11 24 25 compared with control values.…”

Section: Discussionmentioning

confidence: 96%

“…This is especially important for the normal right myocardium, which has a relatively low O 2 metabolism. Animal studies previously reported significantly lower baseline O 2 extraction (−46%)2 4 5 and right coronary artery (RCA) flow (−0.5 ml/min/g)4 5 for the right heart compared with the left heart (O 2 extraction of 60–80% and left coronary artery flow of −1 ml/min/g) 6–8…”

Section: Introductionmentioning

confidence: 99%

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Supine-exercise-induced oxygen supply to the right myocardium is attenuated in patients with severe idiopathic pulmonary arterial hypertension

Wong

Raijmakers

Knaapen³

et al. 2011

Heart

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“…From experimental studies in animals it is known that in the normal right heart the oxygen extraction and coronary flow are much lower than in the left myocardium 10,11. In chronic RV hypertrophy, experimental studies report an elevated oxygen extraction,11,12 whereas other studies observed conflicting baseline right coronary flow or perfusion 3,12–14. It is thus not clear if pressure and HR are the main determinants of MVO 2 of the human diseased right myocardium secondary to IPAH.…”

Section: Introductionmentioning

confidence: 99%

Systolic pulmonary artery pressure and heart rate are main determinants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension

Wong

Westerhof

Ruiter

et al. 2011

European J of Heart Fail

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AimsIncreased afterload in idiopathic pulmonary arterial hypertension (IPAH) causes right ventricular (RV) hypertrophy and failure. Since RV remodelling occurs with alterations in RV oxygen metabolism, increasing our understanding in the factors determining RV O 2 consumption in IPAH is necessary. In the left ventricle, it is known that heart rate and systolic blood pressure are the main determinants of myocardial O 2 consumption (MVO 2 ). However, the normal right heart has lower oxygen extraction and perfusion than the left myocardium, and RV energy metabolism is changed in hypertrophy. Therefore, it is not obvious that the relationsships of pressure and heart rate to MVO 2 hold for the overloaded human right heart. We hypothesize that systolic pulmonary artery pressure (PAP) and heart rate (HR) are the major determinants of RV MVO 2 in IPAH. Methods and resultsIn 18 IPAH patients (New York Heart Association class II and III), RV MVO 2 was determined using positron emission tomography and 15 O tracers. PAP and HR were measured during right heart catheterization. RV MVO 2 was found to be related to systolic PAP (R 2 ¼ 0.54, P , 0.001), and inversely to stroke volume (R 2 ¼ 0.32, P ¼ 0.015) and HR (R 2 ¼ 0.32, P ¼ 0.014). Relationships of MVO 2 to the rate pressure product (RPP), i.e. systolic pressure × HR, and wall stress were R 2 ¼ 0.55, P , 0.001, and R 2 ¼ 0.30, P ¼ 0.020, respectively. Multiple regression of MVO 2 on HR and systolic PAP gave R 2 ¼ 0.59, P ¼ 0.001. ConclusionSystolic PAP and HR are the major determinants of RV MVO 2 in IPAH. A further increase of HR and PAP with IPAH progression suggests a compromised RV myocardial oxygen availability.--

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Coronary flow reserve and oxygen metabolism of the right ventricle.

Cited by 21 publications

References 15 publications

Oxidative metabolism in the myocardium in normal subjects during dobutamine infusion

Oxidative metabolism in the myocardium in normal subjects during dobutamine infusion

Supine-exercise-induced oxygen supply to the right myocardium is attenuated in patients with severe idiopathic pulmonary arterial hypertension

Systolic pulmonary artery pressure and heart rate are main determinants of oxygen consumption in the right ventricular myocardium of patients with idiopathic pulmonary arterial hypertension

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