Right Ventricular Failure Following Chronic Pressure Overload Is Associated With Reduction in Left Ventricular Mass

Hardziyenka, Maxim; Campian, Maria E.; Reesink, Herre J.; Surie, Sulaiman; Bouma, Berto J.; Groenink, Maarten; Klemens, Christine A.; Beekman, Leander; Remme, Carol Ann; Bresser, Paul; Tan, Hanno L.

doi:10.1016/j.jacc.2010.08.648

Cited by 102 publications

(95 citation statements)

References 41 publications

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“…Nevertheless, BPA significantly ameliorated RV dilatation (RVEDVI and RVESVI), RV systolic dysfunction (RVEF), RV hypertrophy (RVMI and VMI), and interventricular septal bowing (septal inversion ratio). Furthermore, there were strong correlations between changes in RV However, this study found that BPA did not significantly affect LV volumes and function, which is consistent with the findings on PEA of IINO et al [21] and KREITNER et al [16], but inconsistent with those of REESINK et al [28] and HARDZIYENKA et al [29]. Some pulmonary hypertension reports have demonstrated that LV systolic and diastolic dysfunction may occur secondary to RV dysfunction through ventricular interaction, ventricular interdependence, early diastolic ventricular septal bowing, and hypertrophy of the interventricular septum [28,30].…”

Section: Beneficial Effects Of Bpa On Haemodynamics and Clinical Statussupporting

confidence: 84%

Right ventricular reverse remodelling after balloon pulmonary angioplasty

et al. 2014

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Balloon pulmonary angioplasty (BPA) has been reported to improve haemodynamics and functional capacity, with an acceptable risk, in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not candidates for pulmonary endarterectomy. However, right ventricular (RV) function, an important predictor in CTEPH, remains to be elucidated. We aimed to examine the impact of BPA on RV remodelling and dysfunction relative to haemodynamic improvements in patients with inoperable CTEPH.20 consecutive patients with inoperable CTEPH who underwent BPA with cardiovascular magnetic resonance before and after BPA were retrospectively studied.BPA led to significant amelioration of the mean pulmonary arterial pressure, cardiac index and pulmonary vascular resistance (PVR), without death or major complications. Furthermore, BPA significantly ameliorated right-sided heart failure symptoms and signs, and exercise capacity. Cardiovascular magnetic resonance revealed a marked improvement in RV end-diastolic and end-systolic volume index, with concomitant improvements in RV ejection fraction, mass and interventricular septal bowing after BPA. Changes in RV volumes strongly correlated with changes in cardiac index and PVR.BPA induced RV reverse remodelling and improved systolic dysfunction safely by ameliorating haemodynamics in patients with inoperable CTEPH. Evaluating RV function with cardiovascular magnetic resonance may be effective for noninvasively monitoring BPA efficacy. @ERSpublications BPA safely ameliorates haemodynamics, leading to right ventricular reverse remodelling in inoperable CTEPH

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Section: Beneficial Effects Of Bpa On Haemodynamics and Clinical Statussupporting

confidence: 84%

Right ventricular reverse remodelling after balloon pulmonary angioplasty

et al. 2014

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“…Iino et al found no significant change in LV function at 6 months after PEA, 25 whereas Hardziyenka et al noted reverse LV remodeling (increased LVEDVI and LVSVI) at 8 months after PEA. 26 Reesink et al noted that LV function normalized owing to the restoration of pulmonary hemodynamics and RV function at least at 4 months after PEA. 6 Based on the results of these PEA studies, 4-6 months may be needed to induce LV remodeling and improve LV function with PEA or BPA.…”

Section: Acknowledgmentsmentioning

confidence: 99%

“…Iino et al found no significant change in LV function after PEA, 25 whereas Hardziyenka et al noted reverse LV remodeling (increased LVEDVI and LVSVI) after the procedure. 26 Galiè et al noted that two mechanisms are involved in the increase in LV size after effective medical treatment in pulmonary arterial hypertension (PAH): (1) increase in RVSV; and (2) decompression of the LV due to decreased RVEDV. 28 In the present study, the extent of the improvement of RVSVI and RVEF were correlated to that of LVEDVI and the extent of the improvement of ISA was also correlated with that of LVEDVI and LVSVI.…”

Section: Acknowledgmentsmentioning

confidence: 99%

Balloon Pulmonary Angioplasty Improves Biventricular Functions and Pulmonary Flow in Chronic Thromboembolic Pulmonary Hypertension

Sato

Ota

Sugimura

et al. 2016

Circ J

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In CTEPH, RV pressure overload causes RV dysfunction and dilation with resulting poor prognosis. 13-15 Precise evaluation of RV function, however, still remains difficult because of anatomical complexity of the RV chamber. Recently, cardiac magnetic resonance imaging (CMR) has been widely used to evaluate RV configuration and function because it non-invasively provides 3-D RV imaging, high-resolution evaluation of RV structure and accurate functional assessment without geometric assumptions. 16 Kreitner et al used CMR to evaluate change in cardiac function and pulmonary flow after PEA in CTEPH patients. 17 Van Wolferen et al reported that in patients with idiopathic pulmonary arterial hypertension (IPAH), both RV and left ventricular (LV) function as measured on CMR were improved after medical treatment, and that improvement of LV end-diastolic volume (LVEDV) was one hronic thromboembolic pulmonary hypertension (CTEPH) is characterized by the presence of organized thrombi in the pulmonary circulation and poor prognosis due to progressive right ventricular (RV) failure. 1,2 Pulmonary endarterectomy (PEA), which surgically removes organized thrombi, can cure CTEPH, 1,3-8 but distal-type CTEPH is not suitable for PEA, 8 and these inoperable CTEPH patients have poor prognosis due to progressive RV failure. As an alternative therapy, Feinstein et al originally developed balloon pulmonary angioplasty (BPA) in 2001. 9 and we and others have recently showed that BPA improves pulmonary hemodynamics, exercise capacity and prognosis in inoperable CTEPH. Background: It remains to be determined whether balloon pulmonary angioplasty (BPA) improves biventricular cardiac functions and pulmonary flow in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

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“…ECG evidence of LVH had well predictive characteristics. LVH is a feature of left heart disease, whereas in PAH, left ventricular atrophy can be present [29]. Left atrial dilation on MRI has high predictive value when comparing PAH and left heart failure [30].…”

Section: Figurementioning

confidence: 99%

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

et al. 2015

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Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH. 300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R 2 =0.66 and area under the curve 0.93. In patients with a risk score ⩾72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases. @ERSpublications A risk score system can identify left-heart failure as alternative PH cause in patients suspected of PAH clinically http://ow.ly/JAIkR

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Right Ventricular Failure Following Chronic Pressure Overload Is Associated With Reduction in Left Ventricular Mass

Abstract: RVF in patients with CTEPH is associated with reversible reduction in LV free wall mass. In a rat model of RVF, myocyte shrinkage due to atrophic remodeling contributed to reduction in LV free wall mass.

Cited by 102 publications

References 41 publications

Right ventricular reverse remodelling after balloon pulmonary angioplasty

Right ventricular reverse remodelling after balloon pulmonary angioplasty

Balloon Pulmonary Angioplasty Improves Biventricular Functions and Pulmonary Flow in Chronic Thromboembolic Pulmonary Hypertension

Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension

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