Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

Küehne, Titus; Yilmaz, Sevim; Steendijk, Paul; Moore, Phillip; Groenink, Maarten; Saaed, Maythem; Weber, O.; Higgins, Charles B.; Ewert, Peter; Fleck, E; Nagel, Eike; Schulze‐Neick, Ingram; Lange, Peter

doi:10.1161/01.cir.0000143138.02493.dd

Cited by 330 publications

(138 citation statements)

References 35 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…16,18 Insufficient increase in contractility to preserve RV-arterial coupling was observed in a patient with a systemic RV in the context of a congenitally corrected transposition of the great arteries 17 and in patients with systemic sclerosis-associated PAH. 18 Thus, it appears that RV-arterial coupling tends to be maintained by an adaptive increase in E max in models such as hypoxic exposure or a few months of aortopulmonary shunting associated with only moderate increase in P pa .…”

Section: Coupling Of Systolic Function To Afterloadmentioning

confidence: 97%

“…15 Single-beat measurements of RV E max have been reported in patients with pulmonary arterial hypertension (PAH), using fluid-filled catheters and magnetic resonance imaging (MRI), 16 and in a patient with a congenitally corrected transposition of the great arteries and a systemic RV, using high-fidelity micromanometer-tipped catheters and transonic measurements of pulmonary flow. 17 Measurements of RV E max have also been reported in idiopathic and systemic sclerosis-associated PAH, using conductance catheter methodology for instantaneous high-fidelity pressure and volume determinations.…”

Section: Systolic Functionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanics of the Right Ventricle in Health and Disease (2013 Grover Conference Series)

Naeije¹,

Brimioulle²,

Dewachter³

2014

Pulm. circ.

107

View full text Add to dashboard Cite

Right ventricular (RV) function is a major determinant of the symptomatology and outcome in pulmonary hypertension. The normal RV is a thin-walled flow generator able to accommodate large changes in venous return but unable to maintain flow output in the presence of a brisk increase in pulmonary artery pressure. The RV chronically exposed to pulmonary hypertension undergoes hypertrophic changes and an increase in contractility, allowing for preserved flow output in response to peripheral demand. Failure of systolic function adaptation (homeometric adaptation, described by Anrep's law of the heart) results in increased dimensions (heterometric adaptation; Starling's law of the heart), with a negative effect on diastolic ventricular interactions, limitation of exercise capacity, and vascular congestion. Ventricular function is described by pressure-volume relationships. The gold standard of systolic function is maximum elastance (E max ), or the maximal value of the ratio of pressure to volume. This value is not immediately sensitive to changes in loading conditions. The gold standard of afterload is arterial elastance (E a ), defined by the ratio of pressure at E max to stroke volume. The optimal coupling of ventricular function to the arterial circulation occurs at an E max /E a ratio between 1.5 and 2. Patients with severe pulmonary hypertension present with an increased E max , a trend toward decreased E max /E a , and increased RV dimensions, along with progression of the pulmonary vascular disease, systemic factors, and left ventricular function. The molecular mechanisms of RV systolic failure are currently being investigated. It is important to refer biological findings to sound measurements of function. Surrogates for E max and E a are being developed through bedside imaging techniques.Keywords: right ventricle, pulmonary hypertension, preload, afterload, maximum elastance, end-systolic elastance, arterial elastance. One must inquire how increasing pulmonary vascular resistance results in impaired right ventricular function.-J. T. Reeves, 1989 1 In 1988, Jack Reeves and his colleagues noted that pulmonary hypertension is a common complication of cardiac and pulmonary diseases, that associated alterations in right ventricular (RV) function cause symptoms and limit survival, and that, paradoxically, research in this area had been relatively scarce. 1 Accordingly, they called for more studies to improve the understanding of RV failure in health and disease. Twenty-five years later, there has been significant progress, but our present knowledge remains incomplete, and calls for more research have been repeated. 2,3 The right ventricle (RV) in mammals and birds is a thin-walled flow generator, designed to accommodate the entire systemic venous return undergoing gas exchange in the pulmonary circulation, which is a separate high-flow, low-pressure system. 4 The pulmonary vascular pressures at rest and at mild levels of exercise are so low that a mean systemic filling pressure in the range of 10-15 m...

show abstract

Section: Coupling Of Systolic Function To Afterloadmentioning

confidence: 97%

Section: Systolic Functionmentioning

confidence: 99%

Biomechanics of the Right Ventricle in Health and Disease (2013 Grover Conference Series)

Naeije¹,

Brimioulle²,

Dewachter³

2014

Pulm. circ.

107

View full text Add to dashboard Cite

show abstract

“…3 This method utilizes P iso , the isovolemic pressure of a nonejecting beat, determined by sine extrapolation of the RV waveform near maxima dP/dt and minima dP/dt (Fig. 2).…”

Section: Case Descriptionmentioning

confidence: 99%

“…The RV increases contractility as an adaptation to sustained increases in afterload. 3 The degree of adaptation of the ventriculovascular unit is typically indicated by the coupling ratio, Ees/Ea. While stroke work is optimized at a coupling ratio of 1.0, 4 studies of experimental PAH indicate that the system is coupled under normal conditions to maximum work for minimum energy cost (efficiency) at a coupling ratio of approximately 1.5-2.0.…”

mentioning

confidence: 99%

Selective Pulmonary Vasodilation Improves Ventriculovascular Coupling and Gas Exchange in a Patient with Unrepaired Single‐Ventricle Physiology

et al. 2015

View full text Add to dashboard Cite

We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.Keywords: pulmonary hypertension, ventricular/vascular coupling hemodynamics, congenital heart disease, treatment effect. Pulmonary arterial hypertension (PAH) is a progressive disease defined by severe pulmonary vasculopathy resulting in high right ventricular (RV) afterload. Although treatment focus is often on the pulmonary vasculopathy, mortality in this disease is most specifically indicated by RV load adaptation. 1 Therefore, there has been recent research emphasis on methods directed toward recognition of early pump dysfunction. One such method is ventriculovascular coupling, a method that describes the hydraulic transfer of energy from the ventricle to the vasculature. 2 This method is not generally thought of in the context of the "coupling" of gas exchange. Functional improvements with therapy are attributed to a combination of improvements in gas exchange and RV function. However, the extent to which each component contributes is unknown.Ventriculovascular coupling is most often described by the coupling ratio, the numeric ratio of ventricular elastance (Ees) to vascular elastance (Ea). Ees is often termed contractility and thought of as a component that is independent of acute changes in preload and afterload, or Ea. The RV increases contractility as an adaptation to sustained increases in afterload. 3 The degree of adaptation of the ventriculovascular unit is typically indicated by the coupling ratio, Ees/Ea. While stroke work is optimized at a coupling ratio of 1.0, 4 studies of experimental PAH indicate that the system is coupled under normal conditions to maximum work for minimum energy cost (efficiency) at a coupling ratio of approximately 1.5-2.0. 5 Pulmonary gas exchange ...

show abstract

“…In addition, CMR approaches have been developed to estimate Ees noninvasively. 33,34 Paradoxically, it has been found that RV contractility is increased in patients with PAH, whereas global measures of RV systolic function, such as RV ejection fraction and stroke volume, are decreased. 35 These findings might be explained by the fact that, although the RV compensates for the increased afterload by hypercontractility, this was insufficient, leading to ventriculo-arterial uncoupling.…”

Section: Global Rv Functionmentioning

confidence: 99%

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

et al. 2014

View full text Add to dashboard Cite

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by remodeling and vasoconstriction of the pulmonary vasculature, ultimately leading to right ventricular (RV) failure and death. Recent developments in echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and positron emission tomography allow advanced, noninvasive, in vivo assessment of the RV and have contributed to the identification of risk factors, prognostic factors, and monitoring of therapeutic responses in patients with PAH. Although far from reaching its future potential, these techniques have not only provided global RV assessment but also allowed evaluation of changes in cellular and molecular tissue processes, such as metabolism, oxygen balance and ischemia, angiogenesis, and apoptosis. Integrated application of these techniques could provide full insights into the different pathophysiological aspects of a failing RV in the setting of PAH. Recent advances in hybrid imaging have implemented simultaneous measurements of myocardial and vascular interactions and will be one of the most important potential future developments.

show abstract

Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

Cited by 330 publications

References 35 publications

Biomechanics of the Right Ventricle in Health and Disease (2013 Grover Conference Series)

Biomechanics of the Right Ventricle in Health and Disease (2013 Grover Conference Series)

Selective Pulmonary Vasodilation Improves Ventriculovascular Coupling and Gas Exchange in a Patient with Unrepaired Single‐Ventricle Physiology

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

Contact Info

Product

Resources

About