Accurate assessment of load-independent right ventricular systolic function in patients with pulmonary hypertension

Trip, Pia; Kind, Taco; Veerdonk, Mariëlle C. van de; Marcus, J. Tim; Man, Frances S. de; Westerhof, Nico; Vonk‐Noordegraaf, Anton

doi:10.1016/j.healun.2012.09.022

Cited by 130 publications

(115 citation statements)

References 32 publications

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“…The choice of the fitted curve, i.e. a sine wave [12][13][14], may also be a limitation and a ''standard'' isovolumic pressure curve obtained from measurements needs to be worked out [35].…”

Section: Possible Limitations Of the Proposed Methodsmentioning

confidence: 99%

“…Changes in filling pressure by vena cava occlusion are the best approach but are often not practical or desirable. Therefore, methods have been developed to obtain Ees from measurement of right ventricular pressure (catheterisation) and volume (MRI) of a single beat [12][13][14], making it a practical method to obtain a load-independent functional characterisation of the right heart. The pressure-volume loop of the right ventricle is, in general, more of a trapezoidal shape than the more rectangular shape of the left ventricle, probably as a result of the very compliant pulmonary tree [15].…”

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confidence: 99%

“…This assumption, however, underestimates Ees in a contractility dependent manner [14] and leads to Ea/ Ees51/EF-1 [11]. The pump function graph: figure 2 shows the so-called pump function graph that relates mean ventricular pressure and SV (for details see caption) [19].…”

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confidence: 99%

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Describing right ventricular function

Vonk‐Noordegraaf

Westerhof

2013

Eur Respir J

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In pulmonary hypertension and other conditions, such as acute respiratory distress syndrome and left heart failure, right ventricular dysfunction is a prognostic determinant. Therefore, functional parameters pertaining to the right heart alone, i.e. independent of its loading conditions, should be used to quantify right ventricular disease progression and the results of treatment. Two methods to quantitatively describe right ventricular function are reviewed, the pressure-volume relationship and the pump function graph; examples of each method are given. How to estimate wall stress and how to describe diastolic ventricular properties are also discussed.

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Section: Possible Limitations Of the Proposed Methodsmentioning

confidence: 99%

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Describing right ventricular function

Vonk‐Noordegraaf

Westerhof

2013

Eur Respir J

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“…13 The isovolumic pressure (P iso ) was obtained by fitting an inverted cosine wave over the RV pressure curve using the isovolumic contraction period (from end diastole to the point of maximal rate of pressure rise [dP/dtmax]) and the isovolumic relaxation period (from minimal dP/dt to the start of diastole) by a semiautomatic Matlab R2008a program (The MathWorks, Natick, MA).…”

Section: Assessment Of Rv End-systolic Elastancementioning

confidence: 99%

Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension

et al. 2013

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I diopathic pulmonary arterial hypertension (PAH) is a rare but fatal disease with a survival rate of 58% at 3 years. Present therapy is unable to normalize pulmonary arterial pressures, and PAH patients ultimately develop right heart failure. Editorial see p 1999 Clinical Perspective on p 2025Previous studies have demonstrated that PAH patients have reduced systolic function as measured by right ventricular Background-The role of right ventricular (RV) diastolic stiffness in pulmonary arterial hypertension (PAH) is not well established. Therefore, we investigated the presence and possible underlying mechanisms of RV diastolic stiffness in PAH patients. Methods and Results-Single-beat RV pressure-volume analyses were performed in 21 PAH patients and 7 control subjects to study RV diastolic stiffness. Data are presented as mean±SEM. RV diastolic stiffness (β) was significantly increased in PAH patients (PAH, 0.050±0.005 versus control, 0.029±0.003; P<0.05) and was closely associated with disease severity. Subsequently, we searched for possible underlying mechanisms using RV tissue of PAH patients undergoing heart/lung transplantation and nonfailing donors. Histological analyses revealed increased cardiomyocyte cross-sectional areas (PAH, 453±31 μm 2 versus control, 218±21 μm 2 ; P<0.001), indicating RV hypertrophy. In addition, the amount of RV fibrosis was enhanced in PAH tissue (PAH, 9.6±0.7% versus control, 7.2±0.6%; P<0.01). To investigate the contribution of stiffening of the sarcomere (the contractile apparatus of RV cardiomyocytes) to RV diastolic stiffness, we isolated and membrane-permeabilized single RV cardiomyocytes. Passive tension at different sarcomere lengths was significantly higher in PAH patients compared with control subjects (>200%; P interaction <0.001), indicating stiffening of RV sarcomeres. An important regulator of sarcomeric stiffening is the sarcomeric protein titin. Therefore, we investigated titin isoform composition and phosphorylation. No alterations were observed in titin isoform composition (N2BA/N2B ratio: PAH, 0.78±0.07 versus control, 0.91±0.08), but titin phosphorylation in RV tissue of PAH patients was significantly reduced (PAH, 0.16±0.01 arbitrary units versus control, 0.20±0.01 arbitrary units; P<0.05). In addition, these measures are highly sensitive to the confounding effects of increased preload and afterload and are therefore not reliable in the setting of PAH. 4 On the other hand, the gold standard of measuring load-independent diastolic stiffness by pressure-volume (PV) analysis is not without risk in PAH patients because it requires temporal preload reduction. Conclusions-RV3 In left heart failure, this was circumvented by the development of single-beat analyses of diastolic PV relationship. 5,6 However, it is unclear whether this analysis could also be used for the RV in PAH.There are several possible contributing factors explaining RV diastolic stiffness in PAH. Hypertrophy and fibrosis are known to increase ventricular stiffness.7 However, RV diastolic stiffn...

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“…A problem with the SV/ESV ratio is the inherent assumption that the ESP-ESV relationship is linear and crosses the origin [43]. This is incorrect, because ventricular volume at a zero filling pressure has to be positive.…”

Section: Volume Measurementsmentioning

confidence: 99%

The right ventricle in pulmonary arterial hypertension

2014

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Pulmonary arterial hypertension (PAH) is a right heart failure syndrome. In early-stage PAH, the right ventricle tends to remain adapted to afterload with increased contractility and little or no increase in right heart chamber dimensions. However, less than optimal right ventricular (RV)-arterial coupling may already cause a decreased aerobic exercise capacity by limiting maximum cardiac output. In more advanced stages, RV systolic function cannot remain matched to afterload and dilatation of the right heart chamber progressively develops. In addition, diastolic dysfunction occurs due to myocardial fibrosis and sarcomeric stiffening. All these changes lead to limitation of RV flow output, increased right-sided filling pressures and under-filling of the left ventricle, with eventual decrease in systemic blood pressure and altered systolic ventricular interaction. These pathophysiological changes account for exertional dyspnoea and systemic venous congestion typical of PAH. Complete evaluation of RV failure requires echocardiographic or magnetic resonance imaging, and right heart catheterisation measurements. Treatment of RV failure in PAH relies on: decreasing afterload with drugs targeting pulmonary circulation; fluid management to optimise ventricular diastolic interactions; and inotropic interventions to reverse cardiogenic shock. To date, there has been no report of the efficacy of drug treatments that specifically target the right ventricle. @ERSpublicationsThe compensatory adaptation of right ventricular structure and function is linked to symptoms and prognosis in PAH http://ow.ly/D5W9R

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Accurate assessment of load-independent right ventricular systolic function in patients with pulmonary hypertension

Cited by 130 publications

References 32 publications

Describing right ventricular function

Describing right ventricular function

Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension

The right ventricle in pulmonary arterial hypertension

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