Effect of negative intrathoracic pressure on left ventricular pressure dynamics and relaxation

Virolainen, Juha; Ventilä, Markku; Turto, Heikki; Kupari, Markku

doi:10.1152/jappl.1995.79.2.455

Cited by 86 publications

(51 citation statements)

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“…Treatment with a bronchodilator for mild to moderate COPD improves respiratory function and exercise tolerance, but does not improve gas exchange abnormalities in the absence of oxygen therapy. 14 Nonetheless, in the present case tiotropium inhalation improved the airway obstruction and also suppressed activation of the sympathetic nerve system via an improvement in both the negative intrathoracic pressure 15,16 and the continuous fatigue of the respiratory muscles. Indeed, the plasma norepinephrine level was decreased significantly.…”

Section: Circulation Journal Vol70 December 2006mentioning

confidence: 54%

Tiotropium, a Novel Muscarinic M3 Receptor Antagonist, Improved Symptoms of Chronic Obstructive Pulmonary Disease Complicated by Chronic Heart Failure

Kato

Komamura

Kitakaze

2006

Circ J

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n the elderly population unrecognized heart failure is very common in patients with stable chronic obstructive pulmonary disease (COPD), 1 and the high prevalence of COPD, chronic heart failure (CHF) and their combination in this group [2][3][4] suggests that customized treatment may be required for such complicated disease status. We report using tiotropium, a non--adrenergic bronchodilator and novel M3 muscarinic receptor antagonist, for COPD complicated with CHF. Case ReportA 77-year-old man was referred to hospital because of dyspnea on exertion. He was a heavy smoker of 60 cigarettes/day for 34 years and had CHF with history of hypertension and mild aortic regurgitation (AR) for 7 years, for which he was being treated with an angiotensin-converting enzyme inhibitor (temocapril, 2 mg) and loop diuretics (furosemide, 20 mg). His weight, blood pressure and heart rate were 56.8 kg, 124/64 mmHg and 80 beats/min, respectively. The breath sounds were decreased with fine rales in both of the posterior lung bases. Physical examination revealed no overt signs of right-sided heart failure, such as dilated jugular vein, hepatomegaly or peripheral edema.Chest X-ray showed increased fibro-linear infiltration in both lung bases ( Fig 1A) and ECG revealed sinus rhythm with complete right bundle branch block and high voltage in the chest leads ( Fig 1B). Laboratory investigations were normal except for a high concentration of brain natriuretic peptide (BNP: 222 pg/ml), which had been chronically elevated at approximately 200-300 pg/ml at least for 2 years.Echocardiography revealed left ventricular (LV) hypertrophy with an enlarged LV cavity and diffuse hypokinesis of the LV wall, with an ejection fraction (EF) of 27%. Right ventricular (RV) dimensions and wall motion were normal. The inferior vena cava showed respiratory movement and was not enlarged. Doppler echocardiography showed early diastolic transmitral flow velocity (E) of 1.2 m/s and the peak diastolic velocity during early filling of the longitudinal mitral annular motion (Ea) was 9.9 cm/s (Fig 2). The E/Ea ratio was 12.2, indicating high LV end-diastolic pressure (LVEDP). 5 The E/A ratio was 0.67, which indicated an abnormal relaxation pattern. Doppler echocardiographic estimated pressure gradient between right atrial (RA) and RV was 22 mmHg (Table 2) and systolic pulmonary artery (PA) pressure was 32 mmHg, indicating hemodynamic load on the right side of the heart. Right-heart catheterization, coronary angiography (CAG) and left ventriculography (LVG) were performed. Pulmonary capillary wedge pressure was 16 mmHg, PA pressure was 30/12 mmHg (mean PA pressure =22 mmHg), RA pressure was 4 mmHg and cardiac output was 5.6 L/min. Pulmonary vascular resistance was 86 dyne· s -1 ·cm -5 . CAG showed normal coronary arteries. LVG revealed diffuse hypokinesis with EF of 30% and mild AR. LVEDP was 14 mmHg. Therefore, we diagnosed left-sided heart failure and hemodynamic load on the right heart with neither pulmonary hypertension nor right-sided heart failure.Pulmonary func...

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Section: Circulation Journal Vol70 December 2006mentioning

confidence: 54%

Tiotropium, a Novel Muscarinic M3 Receptor Antagonist, Improved Symptoms of Chronic Obstructive Pulmonary Disease Complicated by Chronic Heart Failure

Kato

Komamura

Kitakaze

2006

Circ J

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“…24 To the extent that LV compliance is decreased, the LV end-diastolic pressure will tend to rise. 25 Our previous work showed a significant decrease in LVEF during the MM. 16 In the present study, further changes in cardiac function were evidenced with altered S and SR during the MM not only in the LV but also in the RV.…”

Section: Changes In Cardiac Function During the MMmentioning

confidence: 90%

Changes in Left and Right Ventricular Mechanics During the Mueller Maneuver in Healthy Adults

Koshino

Villarraga

Orban

et al. 2010

Circ: Cardiovascular Imaging

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Background— Obstructive sleep apnea is highly prevalent in patients with cardiovascular disease and has detrimental effects on systolic and diastolic function of the ventricles. In this research, the changes in strain (S) and strain rate (SR) during the performance of the Mueller maneuver (MM) in an effort to better understand how negative intrathoracic pressures affect ventricular mechanics. Methods and Results— The MM was performed to maintain a target intrathoracic pressure of −40 mm Hg. Echocardiography was used to measure various parameters of cardiac structure and function. Myocardial deformation measurements were performed using tissue speckle tracking. Twenty-four healthy subjects (9 women; mean age, 30�6 years) were studied. Global left ventricular longitudinal S in systole and SR in early filling were significantly decreased during the MM (S: baseline, −17.0�1.6%; MM, −14.5�2.2%; P <0.0001, SR: baseline, 1.09�0.20 s −1 ; MM, 0.92�0.21 s −1 ; P =0.01). Global right ventricular longitudinal S was also significantly decreased during the MM (baseline, −22.0�3.1%; MM, −17.2�2.5%; P <0.0001), as was global right ventricular longitudinal systolic SR (baseline, −1.34�0.35 s −1 ; MM, −1.02�0.21 s −1 ; P =0.0006). Conclusions— Left ventricular and right ventricular longitudinal deformation are significantly reduced during the MM. These results suggest that negative intrathoracic pressure during apnea may contribute to changes in myocardial mechanics. These results could help explain the observed changes in left ventricular and right ventricular mechanics in patients with obstructive sleep apnea.

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“…All of the aforementioned effects of enhanced negative intrathoracic pressure have been demonstrated to affect left ventricular filling. 35,36 It is difficult to define how each of those mechanisms affects diastolic function in a single OSAS patient, because they would act in synergy. However, in the initial stages of the disease, we hypothesize that mechanical effects of obstructive events mainly create ventricular pressure overload, which by itself might lead to slowed ventricular relaxation.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome Affects Left Ventricular Diastolic Function

et al. 2005

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Background-The purpose of this study was to determine the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for the development of left ventricular diastolic abnormalities. Moreover, we tested the hypothesis that nasal continuous positive airway pressure (nCPAP) improves such alterations in OSAS patients by eliminating apneic events. Methods and Results-In this prospective, randomized, placebo-controlled, double-blind crossover study, 27 consecutive newly diagnosed middle-aged OSAS men with neither controllable factors nor conditions affecting left ventricular diastolic function and 15 healthy control subjects were selected. OSAS patients were randomized to 12 weeks on sham nCPAP and 12 weeks on effective nCPAP application. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, an abnormal left ventricular filling pattern was present in 15 of the 27 OSAS patients and only in 3 of the 15 control subjects (Pϭ0.020). Impaired relaxation was by far the most common abnormal pattern in both groups (11 and 3 patients, respectively). In OSAS patients, 12 weeks on effective nCPAP induced a significant increase in E/A ratio (PϽ0.01), as well as reductions in mitral deceleration (PϽ0.01) and isovolumic relaxation (PϽ0.05) times. Conclusions-OSAS

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Effect of negative intrathoracic pressure on left ventricular pressure dynamics and relaxation

Cited by 86 publications

References 0 publications

Tiotropium, a Novel Muscarinic M3 Receptor Antagonist, Improved Symptoms of Chronic Obstructive Pulmonary Disease Complicated by Chronic Heart Failure

Tiotropium, a Novel Muscarinic M3 Receptor Antagonist, Improved Symptoms of Chronic Obstructive Pulmonary Disease Complicated by Chronic Heart Failure

Changes in Left and Right Ventricular Mechanics During the Mueller Maneuver in Healthy Adults

Obstructive Sleep Apnea Syndrome Affects Left Ventricular Diastolic Function

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