Human right ventricular end-systolic pressure-volume relation defined by maximal elastance.

Brown, Kenneth A.; Ditchey, Roy V.

doi:10.1161/01.cir.78.1.81

Cited by 97 publications

(41 citation statements)

References 39 publications

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“…18 Interestingly, despite having markedly different ventricular geometry and hemodynamics, many studies showed that the RV also follows a time-varying elastance model ( Figure 3). 19,20 Because of the different shape of RV pressure-volume curves, maximal RV elastance better reflects RV contractility than does the end-systolic elastance commonly used in LV pressure-volume interpretation. 20 On the basis of the study by Dell'Italia and Walsh, 20 the normal maximal RV elastance is 1.30Ϯ0.84 mm Hg/mL.…”

Section: Cardiodynamicsmentioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part I

et al. 2008

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I n 1616, Sir William Harvey was the first to describe the importance of right ventricular (RV) function in his seminal treatise, De Motu Cordis: "Thus the right ventricle may be said to be made for the sake of transmitting blood through the lungs, not for nourishing them." 1,2 For many years that followed, emphasis in cardiology was placed on left ventricular (LV) physiology, overshadowing the study of the RV. In the first half of the 20th century, the study of RV function was limited to a small group of investigators who were intrigued by the hypothesis that human circulation could function adequately without RV contractile function. 3 Their studies, however, were based on an open pericardial dog model, which failed to take into account the complex nature of ventricular interaction. In the early 1950s through the 1970s, cardiac surgeons recognized the importance of right-sided function as they evaluated procedures to palliate right-heart hypoplasia. Since then, the importance of RV function has been recognized in heart failure, RV myocardial infarction, congenital heart disease and pulmonary hypertension. More recently, advances in echocardiography and magnetic resonance imaging have created new opportunities for the study of RV anatomy and physiology.The goal of the present review is to offer a clinical perspective on RV structure and function. In the first part, we discuss the anatomy, physiology, aging, and assessment of the RV. In the second part, we discuss the pathophysiology, clinical importance, and management of RV failure. Anatomy of the RV Macroscopic Anatomy of the RVIn the normal heart, the RV is the most anteriorly situated cardiac chamber and lies immediately behind the sternum. In the absence of transposition of great arteries, the RV is delimited by the annulus of the tricuspid valve and by the pulmonary valve. As suggested by Goor and Lillehi, 4 the RV can be described in terms of 3 components: (1) the inlet, which consists of the tricuspid valve, chordae tendineae, and papillary muscles; (2) the trabeculated apical myocardium; and (3) the infundibulum, or conus, which corresponds to the smooth myocardial outflow region 4,5 (Figure 1). In the study of congenital heart disease, this division seems to be more practical than the traditional division of the RV into sinus and conus components. 5 Additionally, the RV can also be divided into anterior, lateral, and inferior walls, as well as basal, mid, and apical sections. 6 Three prominent muscular bands are present in the RV: the parietal band, the septomarginal band, and the moderator band. The parietal band and the infundibular septum make up the crista supraventricularis. 7 The septomarginal band extends inferiorly and becomes continuous with the moderator band, which attaches to the anterior papillary muscle. 7 When abnormally formed or hypertrophied, the septomarginal band can divide the ventricle into 2 chambers (double-chambered RV). 5 Another important characteristic of the RV is the presence of a ventriculoinfundibular fold that separate...

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Section: Cardiodynamicsmentioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part I

et al. 2008

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“…A variety of physiological parameters can be derived from the pressure-volume loops. 23 Because the shape of the pressure-volume curve in the RV is different from that of the LV, maximal elastance (e max ) 24 better reflects RV contractile function than does the end-systolic elastance (Ees) commonly used to determine LV contractile function. 25 RV contractile function can also be measured as PRSW.…”

Section: Indexes Of Contractile Functionmentioning

confidence: 99%

Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

et al. 2002

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Background-We have demonstrated that myocardial acceleration during isovolumic contraction (IVA) is a sensitive index of left ventricular contractile function. In this study, we assessed the utility of IVA to measure right ventricular (RV) contractile function. Methods and Results-We examined 8 pigs by using tissue Doppler imaging of the RV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (e max ), preload recruitable stroke work, and dP/dt max by conductance catheterization. Animals were paced in the right atrium at a rate of 130 beats per minute (bpm).IVA was compared with elastance during contractility modulation by esmolol and dobutamine and during preload reduction and afterload increase by transient balloon occlusion of the inferior vena cava and pulmonary artery, respectively. Data were also obtained during incremental atrial pacing from 110 to 210 bpm. Esmolol led to a decrease in IVA and dP/dt max . During dobutamine infusion, IVA, dP/dt max , preload recruitable stroke work, and e max all increased significantly. During preload reduction and afterload increase, IVA remained constant up to a reduction of RV volume by 54% and an RV systolic pressure increase of 58%. Pacing up to a rate of 190 bpm led to a stepwise increase in IVA and dP/dt max , with a subsequent fall at a pacing rate of 210 bpm. Conclusions-IVA is a measurement of RV contractile function that is unaffected by preload and afterload changes in a physiological range and is able to measure the force-frequency relation. This novel index may be ideally suited to the assessment of acute changes of RV function in clinical studies.

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“…The methodological prerequisites for determining all of the essential parameters of mechanical cardiac action in situ have been available for a long time -and have been improved considerably during the last few years, although some detailed problems remain to be solved (5,7,12,57,59,63,64). However, beyond a merely descriptive presentation ( Fig.…”

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confidence: 99%

Ventricular pressure-volume relations as the primary basis for evaluation of cardiac mechanics Return to Frank's diagram

Jacob

Kissling

1989

Basic Res Cardiol

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Considering ventricular function from the vantage point of the pressure-volume (P-V) diagram permits not only quantification of ventricular working capacity under normal and pathophysiological conditions but also promotes understanding of cardiac dynamics including prediction of the effects of mechanical and pharmacological interventions. Therefore it seems appropriate, at least intellectually, to classify all measured volume and pressure data into the scheme of the P-V diagram. The use of so-called contractility indices and also the restriction to the end-systolic P-V relation alone means deliberate renunciation of important information. In principle, Frank's original concept can be confirmed which, under afterloaded conditions, implies the existence of distinct end-systolic P-V curves each related to a particular end-diastolic volume. As an approximation, however, the assumption of one common end-systolic P-V relation seems tolerable. Based on Frank's diagram, a concept for assessment of ventricular and myocardial function is presented following a discussion of the determinants of the diastolic and end-systolic P-V relations, as well as the methodological difficulties and different notions with regard to the end-systolic P-V curve. The P-V area between the curves of systolic maxima and diastolic minima, up to a defined end-diastolic pressure, is recommended as a measure for quantitative evaluation of ventricular working capacity. Transformation into stress-length (sigma-l) relations is indispensable for assessment of myocardial function under the conditions of changed ventricular geometry. The normalized sigma-l area yields a measure for interindividual evaluation of myocardial working capacity. This concept of evaluation does not mean acknowledgement of the visco-elastic theory of muscle contraction nor of the Emax concept. The P-V and sigma-l relations must, however, be complemented by time related parameters in order to estimate ventricular and myocardial power capacity. After a long-lasting search through international literature for "contractility indices" of general applicability and significance it seems appropriate to return to Frank's diagram as the primary basis for evaluating cardiac mechanics.

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Human right ventricular end-systolic pressure-volume relation defined by maximal elastance.

Cited by 97 publications

References 39 publications

Right Ventricular Function in Cardiovascular Disease, Part I

Right Ventricular Function in Cardiovascular Disease, Part I

Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

Ventricular pressure-volume relations as the primary basis for evaluation of cardiac mechanics Return to Frank's diagram

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