Effects of chronic right ventricular pressure overload on left ventricular diastolic function

Lazar, Jason; Flores, Angel R.; Grandis, Donald J.; Orie, Judith E.; Schulman, Douglas S.

doi:10.1016/0002-9149(93)90990-t

Cited by 47 publications

(37 citation statements)

References 26 publications

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“…This is less likely in the present study population since PH was only mild to moderate. Secondly, since the RV and LV operate as a syncytium, the diastolic function of one ventricle may influence that of the other, and this phenomenon is well recognised as ventricular interdependence [26,27]. The present finding of significant association between Ppa,sys and LV diastolic function indices underlines the presence of ventricular interdependence in patients with IPF.…”

Section: Discussionmentioning

confidence: 52%

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2008

European Respiratory Journal

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It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler echocardiography.IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65¡9 yrs; n522) and healthy individuals (mean age 61¡6 yrs; n522) were studied. Conventional and tissue Doppler echocardiography were used for the evaluation of RV and LV systolic and diastolic function.In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7¡0.2 versus 1.5¡0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (Em; 5.7¡1.1 versus 10.3¡1.6 cm?s -1 , respectively), higher in late diastole (Am; 8.9¡1.3 versus 5.5¡0.8 cm?s -1 , respectively), lower Em/Am ratio (0.6¡0.1 versus 1.9¡0.5, respectively) and higher E/Em ratio (10.8¡3 versus 6¡0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46¡13 versus 83¡21 cm?s -1 , respectively).Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.

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Section: Discussionmentioning

confidence: 52%

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2008

European Respiratory Journal

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“…Impaired diastolic function may precede systolic ventricular dysfunction (13,14), and it influences the performance of the contralateral ventricle via ventricular interdependence (23,34,39). The gold standard for determination of right ventricular (RV) [and left ventricular (LV)] diastolic function is still considered to be cardiac catheterization with simultaneous high-fidelity pressure and volume measurements (32).…”

mentioning

confidence: 99%

Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

Leeuwenburgh

Steendijk²,

Helbing

et al. 2002

American Journal of Physiology-Heart and Circulatory Physiology

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. Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs. Am J Physiol Heart Circ Physiol 282: H1350-H1358, 2002. First published December 13, 2001; 10.1152/ajpheart.00782.2001.-Diastolic function is a major determinant of ventricular performance, especially when loading conditions are altered. We evaluated biventricular diastolic function in lambs and studied possible load dependence of diastolic parameters [minimum first derivative of pressure vs. time (dP/dt min) and time constant of isovolumic relaxation ()] in normal (n ϭ 5) and chronic right ventricular (RV) pressure-overloaded (n ϭ 5) hearts by using an adjustable band on the pulmonary artery (PAB). Pressure-volume relations were measured during preload reduction to obtain the end-diastolic pressure-volume relationship (EDPVR). In normal lambs, absolute dP/dt min and were lower in the RV than in the left ventricle whereas the chamber stiffness constant (b) was roughly the same. After PAB, RV and dP/dt min were significantly higher compared with control. The RV EDPVR indicated impaired diastolic function. During acute pressure reduction, both dP/dt min and showed a relationship with end-systolic pressure. These relationships could explain the increased dP/dt min but not the increased -value after banding. Therefore, the increased after banding reflects intrinsic myocardial changes. We conclude that after chronic RV pressure overload, RV early relaxation is prolonged and diastolic stiffness is increased, both indicative of impaired diastolic function.hemodynamics; hypertrophy; pressure-volume relation; ventricular function, diastole THE IMPORTANCE of diastolic function as a major determinant of ventricular performance has long been recognized. Impaired diastolic function may precede systolic ventricular dysfunction (13,14), and it influences the performance of the contralateral ventricle via ventricular interdependence (23,34,39). The gold standard for determination of right ventricular (RV) [and left ventricular (LV)] diastolic function is still considered to be cardiac catheterization with simultaneous high-fidelity pressure and volume measurements (32).Because RV cineangiography is only sporadically performed during routine diagnostic catheterization and because complex RV geometry hampers adequate RV volume determination, few data are available about RV diastolic function. With the combined pressureconductance catheter it has recently become possible to determine ventricular pressure and volume simultaneously and independently of ventricular geometry in the LV as well as in the RV (3,11).Using this method, we are able to determine parameters of diastolic function such as the end-diastolic pressure-volume relationship (EDPVR) and chamber stiffness constant (b) that are well accepted for LV diastolic analysis. Furthermore, some of the LV relaxation parameters have shown a relationship with load (systolic pressure) that may render them less reliable to characterize intrinsic diastolic properties (26, 33)...

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“…This not only dissipates the high afterload but also results in a more midline septal position, which may enhance left ventricular filling. 11,12 In patients with idiopathic PAH (or those with PAH as a result of pretricuspid shunts), the right ventricle bears the full afterload of a diseased pulmonary vasculature, and left ventricular preload is impaired. This may explain why patients with Eisenmenger syndrome from Cardiac MRI in Eisenmenger Syndrome post-tricuspid shunts have a better prognosis than those with pretricuspid shunts or idiopathic PAH.…”

Section: See Article By Jensen Et Almentioning

confidence: 99%

The Sophistication of Simplicity

Krieger

Valente

2015

Circ: Cardiovascular Imaging

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Effects of chronic right ventricular pressure overload on left ventricular diastolic function

Cited by 47 publications

References 26 publications

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic study

Indexes of diastolic RV function: load dependence and changes after chronic RV pressure overload in lambs

The Sophistication of Simplicity

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