Right ventricular ischemia in patients with primary pulmonary hypertension

Gómez, Arturo; Bialostozky, David; Zajarías, Alan; Santos, E.; Palomar, Andrés; Martínez, María Luisa Martínez; Sandoval, Julio

doi:10.1016/s0735-1097(01)01496-6

Cited by 216 publications

(150 citation statements)

References 20 publications

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“…First, the decrease in β1-adrenergic receptor density in chronic RV pressure overload could explain, in part, the decrease in responsiveness to dobutamine. Secondly, the decrease in capillary density in the presence of a hypertrophied ventricle could contribute to perfusion abnormalities and inefficient myocardial oxygen utilisation leading to impaired contractile reserve [22][23][24][25][26]. Thirdly, a metabolic shift from fatty acid to glucose oxidation has been further described in the stressed right ventricle [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

et al. 2014

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Right ventricular (RV) response to exercise or pharmacological stress is not well documented in pulmonary hypertension (PH). We investigated the relationship between RV reserve and ventricular-arterial coupling.Surgical ligation of the left pulmonary artery was performed in 13 Large White piglets (PH group), thereafter weekly embolisations of the right lower lobe were performed for 5 weeks. A control group of six piglets underwent sham procedures. Right heart catheterisation and echocardiography were performed at week 6. Pressure-volume loops were recorded before and after dobutamine infusion.Induction of experimental PH resulted in a higher mean±SD pulmonary artery pressure (34±9 versus 14±2 mmHg; p<0.01) and in a lower ventricular-arterial coupling efficiency (0.66±0.18 versus 1.24±0.17; p<0.01) compared with controls at 6 weeks. Dobutamine-induced relative changes in RV stroke volume index (SVI) and end-systolic elastance were lower in the PH group (mean±SD 47±5% versus 20±5%, p<0.01, and 81±37% versus 32±14%, p<0.01, respectively). Change in SVI was strongly associated with resting ventricular-arterial coupling (R 2 =0.74; p<0.01). RV reserve was associated with ventricular-arterial coupling in a porcine model of chronic pressure overload. @ERSpublications Dobutamine testing in right ventricular pressure overload: a potentially useful method to assess contractile reserve

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Section: Discussionmentioning

confidence: 99%

Right ventricular reserve in a piglet model of chronic pulmonary hypertension

et al. 2014

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“…Some authors have used thallium scintigraphy and cine MR imaging to study RV pressure overload in PH patients. Perfusion abnormalities suggestive of RV ischaemia are associated with RV dysfunction [123]. Finally, first-pass radionuclide angiography and gated stress myocardial perfusion imaging [124] allow the routine evaluation of RVEF, bearing in mind that RVEF reflects afterload rather than RV contractility.…”

Section: Imagingmentioning

confidence: 99%

Haemodynamic evaluation of pulmonary hypertension

Chemla¹,

Castelain²,

Hervé³

et al. 2002

Eur Respir J

304

185

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Haemodynamic evaluation of pulmonary hypertension. D. Chemla, V. Castelain, P. Hervé, Y. Lecarpentier, S. Brimioulle. #ERS Journals Ltd 2002. ABSTRACT: Pulmonary hypertension is characterised by the chronic elevation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) leading to right ventricular enlargement and hypertrophy. Pulmonary hypertension may result from respiratory and cardiac diseases, the most severe forms occurring in thromboembolic and primary pulmonary hypertension.Pulmonary hypertension is most often defined as a mean PAP w25 mmHg at rest or w30 mmHg during exercise, the pressure being measured invasively with a pulmonary artery catheter. Doppler echocardiography allows serial, noninvasive follow-up of PAPs and right heart function. When the adaptive mechanisms of right ventricular dilatation and hypertrophy cannot compensate for the haemodynamic burden, right heart failure occurs and is associated with poor prognosis.The haemodynamic profile is the major determinant of prognosis. In both primary and secondary pulmonary hypertension, special attention must be paid to the assessment of pulmonary vascular resistance index (PVRI), right heart function and pulmonary vasodilatory reserve.Recent studies have stressed the prognostic values of exercise capacity (6-min walk test), right atrial pressure, stroke index and vasodilator challenge responses, as well as an interest in new imaging techniques and natriuretic peptide determinations. Overall, careful haemodynamic evaluation may optimise new diagnostic and therapeutic strategies in pulmonary hypertension.

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“…The very characteristic finding in our study was the efflux of lactate under the stable fatty acids use in PH group (Figure 1). In RVH, there is a mitochondrial metabolic switch from glucose oxidation to glycolysis due to myocardial ischemia (Pio et al, 2010, Gomez et al, 2001. Positron emission tomography studies in patients with RVH suggested that there is increased RV glucose uptake, which is thought to reflect enhanced glycolysis.…”

Section: Myocardial Use Of Lactate and Other Substrates In Non-cyanotmentioning

confidence: 99%