RV Dysfunction In Pulmonary Hypertension Is Independently Related To Pulmonary Artery Stiffness

Stevens, Gerin R.; García‐Álvarez, Ana; Sahni, Sheila; García, Mario J.; Fuster, Valentín; Sanz, Javier

doi:10.1016/j.jcmg.2011.11.020

Cited by 142 publications

(152 citation statements)

References 38 publications

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“…The linearity of the RVEF-R relationship for RVEF >35% is consistent with the linear relationship observed in mild and moderate PAH. 11 Similar to the linear-R model, the mixed linear model is consistent with the curvilinear RVEF-C relationship observed by Stevens et al 18 In Table 1, we summarize strengths and weaknesses of the three models on the basis of clinical evidence. In Figure 2, we directly compare the results from our models with the empirical correlations derived from the limited clinical data available.…”

Section: Methodssupporting

confidence: 74%

“…As a result, RVEF is clearly more sensitive to changes in C in severe PAH than mild or no PAH, which is supported by clinical evidence. 18 For our second model, we alternatively hypothesize that RV function is equally sensitive to changes in C at any stage of PAH, resulting in a linear relationship between RVEF and C (linear-C model; Fig. 1c, 1d ).…”

Section: Methodsmentioning

confidence: 99%

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What Does the Time Constant of the Pulmonary Circulation Tell us about the Progression of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension?

2015

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Compliance (C ) and resistance (R ) maintain a unique, inverse relationship in the pulmonary circulation, resulting in a constant characteristic time τ ¼ RC that has been observed in healthy subjects as well as patients with pulmonary arterial hypertension (PAH). However, little is known about the dependence of right ventricular (RV) function on the coupled changes in R and C in the context of this inverse relationship. We hypothesized three simple dependencies of RV ejection fraction (RVEF) on R and C. The first model (linear-R ) assumes a linear RVEF-R relation; the second (linear-C ) assumes a linear RVEF-C relation; and the third one combines the former two in a mixed linear model. We found that the linear-R model and the mixed linear model are in good agreement with clinical evidence. A conclusive validation of these models will require more clinical data. Longitudinal data in particular are needed to identify the time course of ventricular-vascular impairment in PAH. Simple models like the ones we present here, once validated, will advance our understanding of the mechanisms of RV failure, which could improve strategies to manage RV dysfunction in PAH. In understanding the progression of right ventricular (RV) failure in pulmonary arterial hypertension (PAH), a key knowledge gap is the mechanisms that underlie the transition from normal RV function to RV dysfunction and failure and how these transitions are dependent on changes in pulmonary vascular function as the disease progresses. Clinical studies have shown that the mechanical properties of the pulmonary vasculature (i.e., resistance [R] and compliance [C ]) correlate with mortality in PAH. [1][2][3] In addition, an inverse relationship exists between C and R in the pulmonary circulation. 4 The time constant τ ¼ RC has been found to be equal to ∼0.5 s in a large clinical population, including patients with and without PAH, patients with different types of PAH, and patients before and after treatment. 4-7 However, it is unclear how pathological changes in vascular R and C mediate RV dysfunction.Here we formulate three hypothetical models to describe the dependence of RV function on the metrics of pulmonary vascular function R and C. We hypothesize that RV function, expressed as RV ejection fraction (RVEF), depends linearly on R or C or on a combination of both. The results from the three models are evaluated on the basis of relevant clinical evidence. METHODSTo describe the dependence of RV function on R and C, we chose a single metric of RV function. Under normal physiological conditions, known mechanisms of RV autoregulation preserve stroke volume (SV ) and cardiac output (CO) in the face of increased afterload. 8 The maintenance of SV or CO may persist in the adaptively functioning RV in mild or moderate PAH; thus, it would be difficult to correlate these parameters with the early phase of disease. RVEF may be a more sensitive metric of PAH progression than SV and CO. 9 RVEF correlates with mean pulmonary artery pressure 10 and pulmonary...

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Section: Methodssupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

What Does the Time Constant of the Pulmonary Circulation Tell us about the Progression of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension?

2015

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“…As Boerrigter et al 24 reported in patients with pulmonary arterial hypertension, progressive enlargement in the pulmonary arterial diameter measured by using cardiac MRI occurs independent of changes in hemodynamics. A possible explanation for this phenomenon is that underlying pulmonary vascular disease decreases pulmonary arterial wall distensibility during stability, 25,26 but the reduced vascular distensibility is overcome during AECOPD by factors such as dynamic hyperinflation, altered gas exchange, hypoxic vasoconstriction, increased circulating volume (pulmonary edema or diastolic dysfunction), increased cardiac output, and inflammation. [27][28][29] Following exacerbations, the vessel returns to its normal size due to its impaired distensibility.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD

Wells

Morrison

Bhatt

et al. 2016

Chest

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“…Indices of proximal PA distensibility or stiffness quantified by echocardiography,13, 14 computed tomography angiography,15 and magnetic resonance imaging12, 16, 17, 18, 19 are attractive noninvasive indices of PH in humans. These indices correlate with “gold standard” invasive measurements of pulmonary vascular resistance and PA pressure,14, 15, 18 are reliable and early noninvasive indicators of PH (even when only exercised‐induced PH is present),16, 18 predict mortality,12, 17, 18 and help predict acute drug responsiveness 19. Recently, a right pulmonary artery distensibility (RPAD) index quantified by echocardiography, essentially a shortening fraction of the right PA, was evaluated in dogs affected with heartworm disease and various degrees of PH 6.…”

mentioning

confidence: 99%

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

Visser

Johnson

et al. 2016

Veterinary Internal Medicne

109

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BackgroundNoninvasive diagnosis of pulmonary hypertension (PH) primarily relies upon Doppler echocardiography of tricuspid regurgitation (TR). However, TR might be absent or difficult to measure.Hypothesis/ObjectivesTo determine the diagnostic value of right pulmonary artery distensibility (RPAD) index for prediction of Doppler‐derived estimates of pulmonary artery (PA) pressure compared to other indices of PH in dogs.AnimalsSixty‐nine client‐owned dogs with TR.MethodsProspective observational study. Dogs were allocated to groups according to TR pressure gradient (TRPG): TRPG <36 mmHg (control, n = 22), TRPG 36–50 (n = 16), TRPG 50–75 (n = 14) and TRPG >75 mmHg (n = 17). Right pulmonary artery distensibility index, acceleration time to peak PA flow (AT), AT: ejection time of PA flow (AT:ET) and main PA size: aorta size (MPA:Ao) were calculated in each dog.ResultsRight pulmonary artery distensibility index demonstrated the strongest correlation (r = −0.90; P < .0001) to TRPG followed by MPA:Ao (r = 0.78; P < .0001), AT (r = −0.69; P < .0001) and AT:ET (r = −0.68; P < .0001). RPAD index possessed the most accurate cutoff (<29.5%; Sensitivity [Sn] 0.84, Specificity [Sp] 0.95) to predict TRPG >50 mmHg compared to AT (<53.9 ms; Sn 0.74, Sp 0.87), AT:ET (<0.30; Sn 0.61, Sp 0.97) and MPA:Ao (>1.04; Sn 0.94, Sp 0.74). All intra‐ and interobserver measurement variabilities exhibited coefficients of variation ≤13%.Conclusions and Clinical ImportanceRight pulmonary artery distensibility index is an accurate predictor of TRPG and should be particularly useful if TR is absent or difficult to measure.

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RV Dysfunction In Pulmonary Hypertension Is Independently Related To Pulmonary Artery Stiffness

Abstract: PA stiffness is independently associated with the degree of RV dysfunction, dilation, and hypertrophy in PH. RV adaptation to chronic pressure overload is related not only to the levels of vascular resistance (steady afterload), but also to PA stiffness (pulsatile load).

Cited by 142 publications

References 38 publications

What Does the Time Constant of the Pulmonary Circulation Tell us about the Progression of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension?

What Does the Time Constant of the Pulmonary Circulation Tell us about the Progression of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension?

Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD

Diagnostic Value of Right Pulmonary Artery Distensibility Index in Dogs with Pulmonary Hypertension: Comparison with Doppler Echocardiographic Estimates of Pulmonary Arterial Pressure

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