Supine, prone, right and left gravitational effects on human pulmonary circulation

Wieslander, Björn; Ramos, Joao G; Ax, Malin; Petersson, Johan; Ugander, Martin

doi:10.1186/s12968-019-0577-9

Cited by 37 publications

(36 citation statements)

References 28 publications

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“…The highest frequency of involvement of the right lung is possibly representative of a larger COVID-19 population despite the small sample, as blood flow distribution in the supine and prone positions is higher to the right lung [ 21 ]. On the other hand, the upper segmental predominance could be the result of the sample size.…”

Section: Discussionmentioning

confidence: 99%

CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis

et al. 2020

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Objectives To describe imaging and laboratory findings of confirmed PE diagnosed in COVID-19 patients and to evaluate the characteristics of COVID-19 patients with clinical PE suspicion. Characteristics of patients with COVID-19 and PE suspicion who required admission to the intensive care unit (ICU) were also analysed. Methods A retrospective study from March 18, 2020, until April 11, 2020. Inclusion criteria were patients with suspected PE and positive real-time reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Exclusion criteria were negative or inconclusive RT-PCR and other chest CT indications. CTPA features were evaluated and severity scores, presence, and localisation of PE were reported. d -dimer and IL-6 determinations, ICU admission, and previous antithrombotic treatment were registered. Results Forty-seven PE suspicions with confirmed COVID-19 underwent CTPA. Sixteen patients were diagnosed with PE with a predominant segmental distribution. Statistically significant differences were found in the highest d -dimer determination in patients with PE and ICU admission regarding elevated IL-6 values. Conclusion PE in COVID-19 patients in our series might predominantly affect segmental arteries and the right lung. Results suggest that the higher the d -dimer concentration, the greater the likelihood of PE. Both assumptions should be assessed in future studies with a larger sample size. Key Points • On CT pulmonary angiography, pulmonary embolism in COVID-19 patients seems to be predominantly distributed in segmental arteries of the right lung, an assumption that needs to be approached in future research. • Only the highest intraindividual determination of d -dimer from admission to CT scan seems to differentiate patients with pulmonary embolism from patients with a negative CTPA. However, interindividual variability calls for future studies to establish cut-off values in COVID-19 patients. • Further studies with larger sample sizes are needed to determine whether the presence of PE could increase the risk of intensive care unit (ICU) admission in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis

et al. 2020

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“… 6 Similarly, in pulmonary hypertension, the prone position is thought to improve gas exchange as well. 7 Thus, for anyone, whose dyspnoea gets better when lying prone could be explained by recruitment of functioning alveolar units in the prone position. Mild pulmonary hypertension is hardly symptomatic making early diagnosis difficult unless suspected.…”

Section: Discussionmentioning

confidence: 99%

Case report of an atrial septal defect with negative transthoracic echocardiography, a diagnostic challenge in a middle-aged female with marked dyspnoea

Liyanapathirana¹,

Arthanayake²,

Widyaratne³

et al. 2021

SAGE Open Medical Case Reports

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A 39-year-old G3P3 female presented with abrupt onset dyspnoea of one month duration. She was markedly symptomatic when lying supine and resorted to prone sleeping. Chest X-ray reported as cardiomegaly. Transthoracic echocardiography was unremarkable twice. Computed tomography chest showed a dilated pulmonary artery. Transesophageal echocardiography identified a 12-mm ostium secundum atrial septal defect with mild pulmonary hypertension. The defect was closed with a cocoon device and rendered her symptom free. This case highlights the importance of timely organization of transesophageal echocardiography when transthoracic echocardiography is negative. It also illustrates marked dyspnoea could be a presentation of undiagnosed atrial septal defect with mild pulmonary hypertension.

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“…A left lateral recumbent position increases the dimensions of the left atrium and the right pulmonary veins and thereby increases local myocardial stress (Wieslander et al, 2019). Stretch of the atria and pulmonary veins is proarrhythmic for AF (Ravelli and Allessie, 1997;Chang et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…self-reported "positional" AF in symptomatic paroxysmal AF (episode duration <1 week) patients and the clinical characteristics of these patients to facilitate their identification in clinical practice. Because stretch of the atrial myocardium is proarrhythmic for AF (Ravelli and Allessie, 1997), and a left lateral body position increases atrial dimensions in humans (Wieslander et al, 2019), we hypothesized that left lateral recumbence is a frequent AF-triggering body position. AF treatment and prevention can be ameliorated by understanding the underlying mechanisms of positional AF.…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position

Gottlieb

Blanco²,

Hocini³

et al. 2021

Front. Physiol.

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Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients.Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France.Results: Ninety-four symptomatic paroxysmal AF patients were included [mean age 61 ± 11 years, median AF history of 29(48) months, 31% were females]. Twenty-two percent of patients reported a specific body position as a trigger of their AF symptoms. The triggering body position was left lateral position in 57% of cases, supine position in 33%, right lateral position in 10%, and prone position in 5% (p = 0.003 overall difference in prevalence). Patients with positional AF had a higher body mass index compared to patients without nocturnal/positional AF [28.7(4.2) and 25.4(5.2) kg/m2, respectively, p = 0.025], but otherwise resembled these patients.Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.

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Supine, prone, right and left gravitational effects on human pulmonary circulation

Cited by 37 publications

References 28 publications

CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis

CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis

Case report of an atrial septal defect with negative transthoracic echocardiography, a diagnostic challenge in a middle-aged female with marked dyspnoea

Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position

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