Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension

Fukumitsu, Masafumi; Westerhof, Berend E.; Ruigrok, Dieuwertje; Braams, Natalia J; Groeneveldt, Joanne A.; Bayoumy, Ahmed A.; Marcus, J. Tim; Meijboom, Lilian J.; Man, Frances S. de; Westerhof, Nico; Bogaard, Harm Jan; Vonk‐Noordegraaf, Anton

doi:10.1152/ajpheart.00442.2020

Cited by 25 publications

(32 citation statements)

References 36 publications

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“…So far, PAH was considered to be associated with a later return of reflected waves than CTEPH (Castelain et al, 2001;Nakayama et al, 2001). Interestingly, however, the arrival time of reflected waves in PAH was comparable to the subtype of CTEPH that had distal lesions of both lungs (distal CTEPH, mean: 63% of systole) (Fukumitsu et al, 2020). Distal CTEPH and PAH may be indistinguishable in terms of the arrival time of reflected waves.…”

Section: Difference Of Wave Reflection Between Pah and Ctephmentioning

confidence: 97%

“…where Pm and Qm were measured pressure and flow curves, respectively, and Zc is characteristic impedance of the proximal PA (Zc) calculated as the averaged modulus between the third and tenth harmonics of PA input impedance (Fukumitsu et al, 2020;Nichols et al, 2011). For example, when HR is 90 bpm, the third to tenth harmonics corresponds to 4.5-15 Hz, a frequency range that should be reliably represented by the measured pressure and flow.…”

Section: Wave Separation Analysismentioning

confidence: 99%

“…Cardiac MRI: RV volume, mass and wall tension RV end-diastolic volume (RVEDV), end-systolic volume (RVESV) and RV mass were obtained by contouring endocardial and epicardial borders of the RV on short-axis at the end-diastolic and end-systolic phase using a medical imaging software (Medis Medical Imaging Systems, Leiden, The Netherlands) (Fukumitsu et al, 2020;Trip et al, 2015;van de Veerdonk et al, 2011). RVEDV, RVESV and RV mass were normalized to body surface area (BSA), respectively.…”

Section: Cardiac Mri: Pa Flow Wavesmentioning

confidence: 99%

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When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension

Fukumitsu

Groeneveldt

Braams

et al. 2022

The Journal of Physiology

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Right ventricular (RV) wall tension in pulmonary arterial hypertension (PAH) is determined not only by pressure, but also by RV volume. A larger volume at a given pressure generates more wall tension. Return of reflected waves early after the onset of contraction, when RV volume is larger, may augment RV load. We aimed to elucidate: (1) the distribution of arrival times of peak reflected waves in treatment-naïve PAH patients; (2) the relationship between time of arrival of reflected waves and RV morphology; and (3) the effect of PAH treatment on the arrival time of reflected waves. Wave separation analysis was conducted in 68 treatment-naïve PAH patients. In the treatment-naïve condition, 54% of patients had mid-systolic return of reflected waves (defined as 34-66% of systole). Despite similar pulmonary vascular resistance (PVR), patients with mid-systolic return had more pronounced RV hypertrophy compared to those with late-systolic or diastolic return (RV mass/body surface area; mid-systolic return 54.6 ± 12.6 g m -2 , late-systolic return 44.4 ± 10.1 g m -2 , diastolic return 42.8 ± 13.1 g m -2 ). Out of 68 patients, 43 patients were further examined after initial treatment. At follow-up, the stiffness of the proximal arteries, given as characteristic impedance, decreased from 0.12 to 0.08 mmHg s mL -1 . Wave speed was attenuated from 13.3 to 9.1 m s -1 , and the return of reflected waves was delayed from 64% to 71% of systole. In conclusion, reflected waves arrive at variable times in PAH. Early return of reflected waves was associated with more RV hypertrophy. PAH treatment not only decreased PVR, but also delayed the timing of reflected waves.

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Section: Difference Of Wave Reflection Between Pah and Ctephmentioning

confidence: 97%

Section: Wave Separation Analysismentioning

confidence: 99%

Section: Cardiac Mri: Pa Flow Wavesmentioning

confidence: 99%

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When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension

Fukumitsu

Groeneveldt

Braams

et al. 2022

The Journal of Physiology

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“…It deserves to explore whether it contributes in some physiology variants to systolic PR or not. Further study design uses invasive pressure–volume conductance catheter technique to assess magnitude and timing of the reflected pressure, and analyses its correlation with RV function, 22 , 23 in patients with or without systolic PR.…”

Section: Discussionmentioning

confidence: 99%

Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure

Hsiao

Chiou

2021

ESC Heart Failure

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Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.

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“…In addition, the timing of the reflected wave pressure correlated with RV dilatation, hypertrophy and wall stress. 23 These reflected pressure waves may therefore explain differences in RV pressure adaptation between CTEPH and iPAH.…”

Section: Rv Physiology and Thromboembolic Diseasementioning

confidence: 99%

Right ventricular adaptation to pressure-overload: Differences between chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension

Braams

Leeuwen

Vonk‐Noordegraaf

et al. 2021

The Journal of Heart and Lung Transplantation

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BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (iPAH) are both associated with right ventricular (RV) failure and mortality. However, CTEPH patients are older, more often male and usually have more co-morbidities than iPAH patients, including a history of venous thromboembolism. Therefore, RV adaptation to pressureoverload in CTEPH may be different than in iPAH. METHODS:We included all treatment-naive CTEPH and iPAH patients diagnosed in the Amsterdam UMC between 2000 and 2019 if cardiac magnetic resonance imaging (CMR) and a right heart catheterization were performed at time of diagnosis. Load-dependent RV volumes and mass were assessed with CMR. Load-independent RV contractility, afterload and diastolic stiffness in relation to afterload were obtained using single beat pressure-volume loop analysis. Differences in RV characteristics between CTEPH and iPAH were analyzed using multiple linear regression with interaction testing after correcting for confounders. RESULTS: We included 235 patients in this study and performed pressure-volume loop analysis in 136 patients. In addition to being older and more often male, CTEPH patients had a lower pulmonary vascular resistance than iPAH patients at the time of diagnosis. After correcting for these confounders, CTEPH patients had a somewhat higher RV end-diastolic volume index (87 § 27 ml vs 82 § 25 ml; p < .01), and a lower RV relative wall thickness (0.6 § 0,1 g/ml vs 0.7 § 0,2 g/ml; p < .01).

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Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension

Cited by 25 publications

References 36 publications

When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension

When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension

Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure

Right ventricular adaptation to pressure-overload: Differences between chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension

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