Methods for Measuring Right Ventricular Function and Hemodynamic Coupling with the Pulmonary Vasculature

Bellofiore, Alessandro; Chesler, Naomi C.

doi:10.1007/s10439-013-0752-3

Cited by 81 publications

(68 citation statements)

References 100 publications

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“…Here, PAP is the pulmonary arterial pressure, PCWP is the pulmonary capillary wedge pressure-approximated as the pressure in the left atrium 12 -CO is the cardiac output, and HR is the heart rate.…”

Section: Methodsmentioning

confidence: 99%

“…11 The initial remodeling response maintains normal RV function but turns counterproductive at the onset of dilation, which is believed to represent the maladaptive form of RV remodeling. 12 The medical community has long believed that PH was a disease that arises as a result of increased resistance in the distal pulmonary vasculature, the cause of which is likely related to a compromise in endothelial response. Endothelial cells lining the pulmonary arteries are known to be highly responsive to the local hemodynamics.…”

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confidence: 99%

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The Role of Wall Shear Stress in the Assessment of Right Ventricle Hydraulic Workload

et al. 2015

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Pulmonary hypertension (PH) is a devastating disease affecting approximately 15-50 people per million, with a higher incidence in women. PH mortality is mostly attributed to right ventricle (RV) failure, which results from RV hypotrophy due to an overburdened hydraulic workload. The objective of this study is to correlate wall shear stress (WSS) with hemodynamic metrics that are generally accepted as clinical indicators of RV workload and are well correlated with disease outcome. Retrospective right heart catheterization data for 20 PH patients were analyzed to derive pulmonary vascular resistance (PVR), arterial compliance (C), and an index of wave reflections (Γ). Patient-specific contrast-enhanced computed tomography chest images were used to reconstruct the individual pulmonary arterial trees up to the seventh generation. Computational fluid dynamics analyses simulating blood flow at peak systole were conducted for each vascular model to calculate WSS distributions on the endothelial surface of the pulmonary arteries. WSS was found to be decreased proportionally with elevated PVR and reduced C. Spatially averaged WSS (SAWSS) was positively correlated with PVR (R 2 ¼ 0.66), C (R 2 ¼ 0.73), and Γ (R 2 ¼ 0.5) and also showed promising preliminary correlations with RV geometric characteristics. Evaluating WSS at random cross sections in the proximal vasculature (main, right, and left pulmonary arteries), the type of data that can be acquired from phase-contrast magnetic resonance imaging, did not reveal the same correlations. In conclusion, we found that WSS has the potential to be a viable and clinically useful noninvasive metric of PH disease progression and RV health. Future work should be focused on evaluating whether SAWSS has prognostic value in the management of PH and whether it can be used as a rapid reactivity assessment tool, which would aid in selection of appropriate therapies.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

The Role of Wall Shear Stress in the Assessment of Right Ventricle Hydraulic Workload

et al. 2015

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“…The pulmonary circulation is fundamentally different to the systemic circulation; therefore, the contractile performance of the better characterised left ventricle (LV) is not transferrable to the RV [9]. A better understanding of RV diastolic dysfunction is needed clinically as two important questions remain unanswered.…”

Section: Introductionmentioning

confidence: 99%

RV diastolic dysfunction: time to re-evaluate its importance in heart failure

et al. 2015

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Right ventricular (RV) diastolic dysfunction was first reported as an indicator for the assessment of ventricular dysfunction in heart failure a little over two decades ago. However, the underlying mechanisms and precise role of RV diastolic dysfunction in heart failure remain poorly described. Complexities in the structure and function of the RV make the detailed assessment of the contractile performance challenging when compared to its left ventricular (LV) counterpart. LV dysfunction is known to directly affect patient outcome in heart failure. As such, the focus has therefore been on LV function. Nevertheless, a strategy for the diagnosis and assessment of RV diastolic dysfunction has not been established. Here, we review the different causal mechanisms underlying RV diastolic dysfunction, summarising the current assessment techniques used in a clinical environment. Finally, we explore the role of load-independent indices of RV contractility, derived from the conductance technique, to fully interrogate the RV and expand our knowledge and understanding of RV diastolic dysfunction. Accurate assessment of RV contractility may yield further important prognostic information that will benefit patients with diastolic heart failure.

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“…The metrics of RV efficiency and ventricular-vascular coupling in the subject with asymptomatic PVD before PAH detection could serve as end points for clinical prevention trials (39).…”

Section: Novel Methods To Detect Pvd Before Pah Is Presentmentioning

confidence: 99%

Pulmonary Hypertension: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

Austin

Kawut²,

Gladwin³

2014

Annals ATS

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Pulmonary vascular dysfunction (PVD) precedes the onset of clinical signs and symptoms of pulmonary arterial hypertension (PAH). PAH is defined by the elevation of pulmonary arterial pressure, which often progresses to right ventricular (RV) dysfunction and failure. PAH affects subjects of all ages, and is associated with diverse medical conditions, most of which are rare. Several factors pose immediate challenges to the development of strategies for primary prevention of PAH, including: (1) the idiopathic or primary form of the disease is extremely rare, limiting screening practicality; (2) methods for the detection of preclinical PVD are currently not established; (3) the understanding of determinants of pulmonary vascular growth, structure, and function in normal and PAH states is insufficient; (4) relatively small numbers of "at-risk" subjects are available for long-term studies to accurately assess disease development; and (5) preventative therapies for PVD are lacking. Despite these limitations, leveraging known at-risk patient populations for study, as well as growing progress across multiple disciplines, ranging from systems biology to advanced and more sensitive functional imaging modalities, may facilitate the opportunity to significantly improve primary prevention research and implementation over the next decade.

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Methods for Measuring Right Ventricular Function and Hemodynamic Coupling with the Pulmonary Vasculature

Cited by 81 publications

References 100 publications

The Role of Wall Shear Stress in the Assessment of Right Ventricle Hydraulic Workload

The Role of Wall Shear Stress in the Assessment of Right Ventricle Hydraulic Workload

RV diastolic dysfunction: time to re-evaluate its importance in heart failure

Pulmonary Hypertension: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

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