2016
DOI: 10.1161/circheartfailure.115.002729
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Impaired Right Ventricular–Pulmonary Arterial Coupling and Effect of Sildenafil in Heart Failure With Preserved Ejection Fraction

Abstract: Background Right ventricular (RV) dysfunction (RVD) is a poor prognostic factor in heart failure (HF) with preserved ejection fraction (HFpEF). The physiologic perturbations associated with RVD or RV function indexed to load (RV-pulmonary arterial (PA) coupling) in HFpEF have not been defined. HFpEF patients with marked impairment in RV-PA coupling may be uniquely sensitive to sildenafil. Methods and Results In a subset of HFpEF patients enrolled in the RELAX trial, physiologic variables and therapeutic effe… Show more

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Cited by 82 publications
(35 citation statements)
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“…This contrasts with responses seen in HFpEF where oxygen extraction is typically increased in response to low cardiac output. In isolated HFpEF, exercise left ventricular filling has been shown to depend heavily on the myocardial reserve of both the left and right ventricle (Hussain et al 2016 ), however greater biventricular interactions in obesity due to higher chamber volumes and greater pericardial restraint may have a deleterious effect. Our data support right ventricular contractile impairment arising due to higher pulmonary afterload although an intrinsic obesity effect is also implicated.…”
Section: Discussionmentioning
confidence: 99%
“…This contrasts with responses seen in HFpEF where oxygen extraction is typically increased in response to low cardiac output. In isolated HFpEF, exercise left ventricular filling has been shown to depend heavily on the myocardial reserve of both the left and right ventricle (Hussain et al 2016 ), however greater biventricular interactions in obesity due to higher chamber volumes and greater pericardial restraint may have a deleterious effect. Our data support right ventricular contractile impairment arising due to higher pulmonary afterload although an intrinsic obesity effect is also implicated.…”
Section: Discussionmentioning
confidence: 99%
“…37 Noninvasive surrogates for RV-PA coupling are emerging, such as tricuspid annular plane systolic excursion to PA systolic pressure ratio, but have yet to be evaluated in the TAVR population. 38 …”
Section: How To Quantify Rv Systolic Function?mentioning
confidence: 99%
“…However, validation of a non-invasive ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) has been shown to accurately provide similar results, which are prognostically significant in heart failure populations. 56…”
Section: Introductionmentioning
confidence: 99%