Ventricular interdependence: Significant left ventricular contributions to right ventricular systolic function

Santamore, William P.; Dell’Italia, Louis J.

doi:10.1016/s0033-0620(98)80049-2

Cited by 485 publications

(350 citation statements)

References 121 publications

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“…Experimental studies have shown that about 20% to 40% of the RV systolic pressure and volume outflow result from LV contraction. 17 Oboler et al in 1973, 18 by recording high-fidelity pressure from the left and right ventricles of anesthetized dogs, demonstrated that the derivative of the RV pressure is composed of the intrinsically generated pressure plus the LV component.…”

Section: Discussionmentioning

confidence: 99%

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cappelli

Porciani

Ricceri

et al. 2010

Clinical Cardiology

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Background: The beneficial effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) remodeling have been extensively described. Few data are available about the effects of CRT on right ventricular (RV) function and remodeling. Hypothesis: We hypothesized that CRT could also induce reverse remodeling in the right ventricle and that RV baseline functional status expressed as tricuspidal annular plane systolic excursion (TAPSE) could affect CRT response. Methods: Echocardiographic investigation was performed before and 6 months after CRT. In 192 patients, TAPSE, LV, and RV dimensions with functional parameters and LV dyssynchrony index were evaluated. Results: At 6 months' follow-up, 86 patients (45%) were responders to CRT according to at least 15% LV endsystolic volume reduction. Among baseline echocardiographic parameters, responders had significantly lower TAPSE, larger LV volumes, and higher LV dyssynchrony index. In responders, LV volume reduction, ejection fraction increase, and mitral regurgitation improvement were associated with RV dimensions reduction, increased TAPSE, and improved LV dyssynchrony. Receiver operating characteristic curve analysis showed that TAPSE, at 17 mm optimal cutoff, yielded 64% sensitivity and 60% specificity in predicting CRT response; similarly, LV dyssynchrony index, at 41.25 ms optimal cutoff, predicted CRT response with 60% sensitivity and 62% specificity. A subgroup analysis demonstrated that the coexistence of high TAPSE and high dyssynchrony index values increased probability of CRT response. Conclusions: Our results show that CRT induces RV and LV reverse remodeling and that CRT patient selection can be improved by simply measuring TAPSE value. IntroductionCongestive heart failure (CHF) is a major disorder associated with poor quality of life and high mortality. 1 At present, cardiac resynchronization therapy (CRT) is a new, well-established therapeutic strategy for patients with drugrefractory symptoms, advanced left ventricular (LV) systolic dysfunction, and wide QRS. 2 -7 However, because it was primarily developed to improve function and synchronism of the LV, the effects of CRT on right ventricular (RV) function have not been fully examined.The importance of the right ventricle has often been underestimated; it was long considered mainly as a conduit and the importance of its contractile performance was undervalued. Nowadays, few data are available about the effects of CRT on RV function and remodeling. 8 -10 Moreover, data about the relationship between baseline RV functional status and long-term LV reverse remodeling

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Section: Discussionmentioning

confidence: 99%

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cappelli

Porciani

Ricceri

et al. 2010

Clinical Cardiology

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“…It is possible that ventricular interdependence and load dependency explain the lack of persistent systolic impairment observed after RP. Up to 50% of RV function is derived from the LV, so that improvement in LV function, as may occur after relief of aortic stenosis by TAVR, will augment load‐dependent RV systolic performance 30. When load‐independent indices of RV function are assessed, RV systolic dysfunction persists into recovery at 15 minutes after cessation of RP.…”

Section: Discussionmentioning

confidence: 99%

Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies

Axell

Giblett

White

et al. 2017

JAHA

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BackgroundWe sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans.Methods and ResultsTen subjects with single‐vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low‐pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia‐induced diastolic dysfunction was seen 1 minute after RP (end‐diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, P<0.001) and BO (end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 8.7±4.0, P=0.03). Impairment of systolic and diastolic function after BO remained at 15‐minutes recovery (ejection fraction [%]: 55.7±9.0 versus 47.8±6.3, P<0.01; end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 9.2±3.9, P<0.01). Persistent diastolic dysfunction was also evident in the RP group at 15‐minutes recovery (end‐diastolic pressure [mm Hg]: 8.1±4.1 versus 9.9±4.4, P=0.03) and there was also sustained impairment of load‐independent indices of systolic function at 15 minutes after RP (end‐systolic elastance and ventriculo‐arterial coupling [mm Hg/mL]: 1.25±0.31 versus 0.85±0.43, P<0.01).ConclusionsRP and right coronary artery balloon occlusion both cause ischemic right ventricular dysfunction with stunning observed later during the procedure. This may have intraoperative implications in patients without right ventricular functional reserve.

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“…Previous work has shown that anything up to 20-40% of RV systolic pressure and volume load may originate from contraction from the LV [14]. Conversely, left bundle branch block (LBBB) may interfere with ventricular activation and induce mechanical dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

Alpendurada

Guha

Sharma

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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BackgroundCardiac resynchronization therapy (CRT) is an established treatment in advanced heart failure (HF). However, an important subset does not derive a significant benefit. Despite an established predictive role in HF, the significance of right ventricular (RV) dysfunction in predicting clinical benefit from CRT remains unclear. We investigated the role of RV function, assessed by cardiovascular magnetic resonance (CMR), in predicting response to and major adverse clinical events in HF patients undergoing CRT.MethodsSixty consecutive patients were evaluated with CMR prior to CRT implantation in a tertiary cardiac centre. The primary end-point was a composite of death from any cause or unplanned hospitalization for a major cardiovascular event. The secondary end-point was response to therapy, defined as improvement in left ventricular ejection fraction ≥ 5% on echocardiography at one year.ResultsEighteen patients (30%) met the primary end-point over a median follow-up period of 26 months, and 27 out of 56 patients (48%) were considered responders to CRT. On time-to-event analysis, only atrial fibrillation (HR 2.6, 95% CI 1.02-6.84, p = 0.047) and RV dysfunction, either by a reduced right ventricular ejection fraction-RVEF (HR 0.96, 95% CI 0.94-0.99, p = 0.006) or tricuspid annular plane systolic excursion-TAPSE (HR 0.88, 95% CI, 0.80-0.96, p = 0.006), were significant predictors of adverse events. On logistic regression analysis, preserved RVEF (OR 1.05, 95% CI 1.01-1.09, p = 0.01) and myocardial scar burden (OR 0.90, 95% CI 0.83-0.96, p = 0.004) were the sole independent predictors of response to CRT. Patients with marked RV dysfunction (RVEF < 30%) had a particularly low response rate (18.2%) to CRT.ConclusionsRight ventricular function is an important predictor of both response to CRT and long-term clinical outcome. Routine assessment of the right ventricle should be considered in the evaluation of patients for CRT.

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Ventricular interdependence: Significant left ventricular contributions to right ventricular systolic function

Cited by 485 publications

References 121 publications

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies

Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy

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