Right Ventricular Oscillatory Power Is a Constant Fraction of Total Power Irrespective of Pulmonary Artery Pressure

Saouti, Nabil; Westerhof, Nico; Helderman, Frank; Marcus, J. Tim; Boonstra, Anco; Postmus, Pieter E.; Vonk‐Noordegraaf, Anton

doi:10.1164/rccm.200910-1643oc

Cited by 122 publications

(97 citation statements)

References 25 publications

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“…Oscillations play a more important role in the pulmonary vascular bed and, therefore, the RV oscillatory power fraction is much larger (23-33%) [36,55] than in its systemic counterpart. However, in contrast to systemic hypertension oscillatory power fraction remains constant in pulmonary hypertension [53].…”

Section: Comparison Of Pulmonary and Systemic Circulationmentioning

confidence: 85%

“…It has been found that oscillatory power is ,23% of total power (and mean power plus oscillatory power being total power is 23/(100-23)5 23/77 or ,30% of mean power), and that this fraction is remains the same in healthy subjects Reproduced from [27] with permission from the publisher. and in subjects with PAH [53]. This constant fraction is the result of the proportionality of pressures, (mean over systolic pressure) and, therefore, also follows on from the constancy of RC.…”

Section: Consequences Of the Constant Product Of Resistance And Complmentioning

confidence: 87%

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The arterial load in pulmonary hypertension

Saouti¹,

Westerhof²,

Postmus³

et al. 2010

Eur Respir Rev

186

153

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The anatomical differences between the pulmonary and systemic arterial system are the main cause of the difference in distribution of compliance. In the pulmonary arterial system compliance is distributed over the entire arterial system, and stands at the basis of the constancy of the RC-time. This distribution depends on the number of peripheral vessels, which is ,8-10 times more in the pulmonary system than the systemic tree. In the systemic arterial tree the compliance is mainly located in the aorta (80% of total compliance in thoracic-abdominal aorta).The constant RC-time in the pulmonary bed results in proportionality of systolic and diastolic pressure with mean pressure and, in turn, in the constant ratio of oscillatory and mean power.KEYWORDS: Compliance, pulmonary hypertension, resistance, systemic circulation, Windkessel T he common feature of pulmonary and the systemic circulation is that both transport an equal amount of blood. However, a major difference is that the pulmonary circulation works at much lower pressures than the systemic circulation. Pulmonary pressure is lower as resistance is lower and the pulmonary vasculature is more compliant. In pulmonary hypertension, the right ventricular load increases due to an increase in pulmonary vascular resistance and decrease in pulmonary vascular compliance, ultimately leading to right ventricular failure. In recent years it has become clear that in pulmonary hypertension not only the contribution of resistance is of importance but that the decrease in arterial compliance plays an equally important role. In addition, in pulmonary hypertension the changes in resistance and compliance are fundamentally and quantitatively different from those in systemic hypertension. Therefore, changes in the pulmonary arterial tree and in pressure are considerably larger than in the systemic arterial tree.This review describes the most important components of the arterial load on the right ventricle (RV) in terms of resistance and arterial compliance, and the consequences of load changes for right ventricular work and function. We will conclude with a short comparison of the pulmonary and systemic circulation in health and hypertension. While the hydraulic load describes the load that the ventricular pump experiences, the muscles generate and feel wall stress, which is considered the muscular afterload. In general higher impedance relates to higher wall stress.

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Section: Comparison Of Pulmonary and Systemic Circulationmentioning

confidence: 85%

Section: Consequences Of the Constant Product Of Resistance And Complmentioning

confidence: 87%

The arterial load in pulmonary hypertension

Saouti¹,

Westerhof²,

Postmus³

et al. 2010

Eur Respir Rev

186

153

View full text Add to dashboard Cite

show abstract

“…To assess RV function, we calculated RV mean power, expressed in joules per second, as HR Â mPAP Â stroke volume (SV) Â 2.22 Â 10 −6 , at rest and at maximum exercise. 8 The relationship between ΔmPAP and ΔQt was assessed both graphically and by calculating the slopes of these relationships from the 3 study points (rest and submaximal and maximal exercise) for individual patients. We also calculated total PVR indexed to BSA (TPVRi), calculated as mPAP/CI.…”

Section: Methodsmentioning

confidence: 99%

Impaired Exercise Capacity following Atrial Septal Defect Closure: An Invasive Study of the Right Heart and Pulmonary Circulation

et al. 2014

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Patients with early repair of an isolated atrial septal defect (ASD) are expected to have unremarkable right ventricular (RV) and pulmonary circulation physiology. Some studies, however, suggest persistent functional impairment. We aimed to examine the role of abnormal RV and pulmonary vascular response to exercise in patients who had undergone ASD closure. Using a previously published data set, we reviewed invasive exercise cardiopulmonary testing with right-sided hemodynamic data for 12 asymptomatic patients who had undergone ASD closure. The 5 (42%) patients with impaired maximal oxygen uptake (V : o 2max ) were older and exhibited a lower peak cardiac index (5.6 AE 0.8 vs. 9.0 AE 1.2 L/min/m 2 ; P ¼ .005) because of abnormal stroke volume augmentation (þ3.2 AE 3.9 vs. þ17.4 AE 10.2 mL/m 2 ; P ¼ .02). While all resting hemodynamic variables were similar, patients with low V :o 2max tended to have abnormal total pulmonary vascular resistance change during exercise (þ11% AE 41% vs. −28% AE 26%; P ¼ .06) and had a steeper relation between mean pulmonary arterial pressure and cardiac index (5.8 AE 0.6 vs. 2.2 AE 0.1 L/min/m 2 ; P ¼ .02). The increase in peak mean RV power during exercise was also significantly lower in the impaired-V: o 2max patients (4.7 AE 1.6 vs. 7.6 AE 2.1 J/s; P ¼ .04). As described in the original study, despite normal resting hemodynamics, a subset of asymptomatic patients with repaired ASD had diminished exercise capacity. Our analysis allows us to conclude that this is due to a combination of abnormal pulmonary vascular response to exercise and impaired RV function.

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“…intraventricular pressure minus intrapericardial pressure. During ejection, intraventricular pressure depends on pulmonary artery pressure, which itself depends on CO, pulmonary vascular resistance and compliance [9].…”

Section: Preload and Afterloadmentioning

confidence: 99%

Fluid therapy in critically ill patients: perspectives from the right heart

Elbers

Rodrigus²,

Nossent

et al. 2015

Anaesthesiol Intensive Ther

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As right heart function can affect outcome in the critically ill patient, a thorough understanding of factors determining right heart performance in health and disease is pivotal for the critical care physician. This review focuses on fluid therapy, which remains controversial in the setting of impending or overt right heart failure. In this context, we will attempt to elucidate which patients are likely to benefit from fluid administration and for which patients fluid therapy would likely be harmful. Following a general discussion of right heart function and failure, we specifically focus on important causes of right heart failure in the critically ill, i.e. sepsis induced myocardial dysfunction, the acute respiratory distress syndrome, acute pulmonary embolism and the effects of positive pressure ventilation. It is argued that fluid therapy should always be cautiously administered with the right heart in mind, which calls for close multimodal monitoring.

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Right Ventricular Oscillatory Power Is a Constant Fraction of Total Power Irrespective of Pulmonary Artery Pressure

Cited by 122 publications

References 25 publications

The arterial load in pulmonary hypertension

The arterial load in pulmonary hypertension

Impaired Exercise Capacity following Atrial Septal Defect Closure: An Invasive Study of the Right Heart and Pulmonary Circulation

Fluid therapy in critically ill patients: perspectives from the right heart

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