Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension

Menzel, Thomas; Wagner, Stefan; Kramm, Thorsten; Mohr-Kahaly, Susanne; Mayer, Eckhard; Braeuninger, Susanne; Meyer, J.

doi:10.1378/chest.118.4.897

Cited by 164 publications

(99 citation statements)

References 33 publications

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“…Conversely, LV systolic function, as measured by both standard 2D and TDI echocardiography, was preserved in the present IPF patients, another finding that is in keeping with previous reports evaluating LV systolic function in clinical entities that affect RV performance [4][5][6][7][8][9][10][11][12].…”

Section: Discussionsupporting

confidence: 91%

“…Right ventricular (RV) dysfunction has been well described in IPF patients, and in several conditions affecting pulmonary circulation, such as primary PH, chronic obstructive pulmonary disease, chronic thromboembolic PH, systemic sclerosis, systemic lupus erythematosus and cystic fibrosis [4][5][6][7][8][9][10]. Moreover, left ventricular (LV) diastolic dysfunction has been reported in some of these conditions [5-7, 11, 12], mainly as a consequence of RV pressure overload.…”

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confidence: 99%

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Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2007

Eur Respir J

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It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler echocardiography.IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65¡9 yrs; n522) and healthy individuals (mean age 61¡6 yrs; n522) were studied. Conventional and tissue Doppler echocardiography were used for the evaluation of RV and LV systolic and diastolic function.In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7¡0.2 versus 1.5¡0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (Em; 5.7¡1.1 versus 10.3¡1.6 cm?s -1 , respectively), higher in late diastole (Am; 8.9¡1.3 versus 5.5¡0.8 cm?s -1 , respectively), lower Em/Am ratio (0.6¡0.1 versus 1.9¡0.5, respectively) and higher E/Em ratio (10.8¡3 versus 6¡0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46¡13 versus 83¡21 cm?s -1 , respectively).Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2007

Eur Respir J

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“…Triküspit yetersizliği anülüs dilatasyonu, sağ ventrikül geometrisinde deği-şiklik ve triküspit kordasında gerilmeye bağlı olabilir (14,15). Triküspit yetersizliğinin derecesi ile pulmoner hipertansiyonun ciddiyeti ve PAB değerleri her zaman uyumlu değildir.…”

Section: Sağ Ventrikül Miyokardiyal Performans Indeksi (Tei Indeksi)unclassified

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Özben

Başaran²

2010

Anadolu Kardiyol Derg

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It is essential to diagnose pulmonary arterial hypertension in early stages of the disease. However, most patients have late diagnosis due to the lack of disease-specific symptoms and prominent findings. Although cardiac catheterization is the gold standard in the diagnosis of pulmonary arterial hypertension, noninvasive diagnostic modalities do also have major roles in the diagnosis, risk assessment and follow-up of the patients with pulmonary arterial hypertension. The focus of the present review is the clinical role of echocardiography and other imaging modalities in pulmonary arterial hypertension. ÖZETPrognozu oldukça kötü olan pulmoner arteriyel hipertansiyonda tanının hastalığın erken dönemlerinde konulması oldukça önemlidir. Ancak semptomların spesifik olmaması ve hastalık bulgularının silik olması nedeniyle, birçok hastada tanıyı koymada geç kalınmaktadır. Tanıda altın standart olarak kardiyak kateterizasyon kabul edilse de, pulmoner arteriyel hipertansiyon tanı, risk değerlendirmesi ve tedavi takibinde noninvazif tanı yöntemlerinin yeri büyüktür. Bu derlemenin konusu pulmoner arteriyel hipertansiyon tanısında kullanılan ekokardiyografi ve diğer görüntüleme yöntemleridir.

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“…Thus, therapeutic strategies for management of RV contractile failure have concentrated on maneuvers to reduce RV afterload, such as pulmonary thromboendarterectomy or fibrinolysis in pulmonary embolism [6,7], inhaled nitric oxide following cardiopulmonary bypass or cardiac transplant [4], and on use of positive inotropic agents such as dobutamine. While there is no question that global RV ejection fraction sometimes improves with such therapeutic interventions, response to these interventions is highly variable.…”

Section: Introductionmentioning

confidence: 99%

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

Greyson

Schwartz

et al. 2008

Journal of Molecular and Cellular Cardiology

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Objective-Right ventricular contractile failure from acute RV pressure overload is an important cause of morbidity and mortality, but the mechanism of RV failure in this setting is incompletely defined. We hypothesized that RV dysfunction from acute RV pressure overload is in part due to activation of calpain, and that calpain inhibition would therefore attenuate RV dysfunction.Methods-Anesthetized, open chest pigs were treated with the calpain inhibitor MDL-28170 or with inactive vehicle, and then subjected to acute RV pressure overload for 90 min. RV contractile function was assessed by the regional Frank-Starling relation. RV myocardial tissue was analyzed for evidence of calpain activation and calpain-mediated proteolysis.Results-RV pressure overload caused severe contractile dysfunction, along with significant alterations in the endogenous calpain inhibitor calpastatin typical of calpain activation. MDL-28170 attenuated RV free wall dysfunction by more than 50%. However, there were no differences in degradation of spectrin, desmin, troponin-I or SERCA2 between SHAM operated pigs and pigs subjected to acute RV pressure overload, or between vehicle and MDL-28170 treated pigs.Conclusions-Acute RV pressure overload causes calpain activation, and RV contractile dysfunction from acute RV pressure overload is attenuated by the calpain inhibitor MDL-28170; however, the effect is not explained by inhibition of calpain-mediated degradation of spectrin, desmin, troponin-I or SERCA2. Since this is the first report of any agent that can directly attenuate RV contractile dysfunction in acute RV pressure overload, further investigation of the mechanism of action of MDL-28170 in this setting is warranted.

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Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension

Cited by 164 publications

References 33 publications

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Echocardiography and other imaging modalities in pulmonary arterial hypertension

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

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