Influence of Left Ventricular Isovolumic Pressure Upon Right Ventricular Pressure Transients

Oboler, Allen A.; Keefe, John F.; Gaasch, William H.; Banas, John S.; Levine, Herbert J.

doi:10.1159/000169617

Cited by 65 publications

(21 citation statements)

References 17 publications

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“…The available experimental evidence, supported by the present study, suggests that LV contraction tends to reduce the volumes of both ventricles. [13][14][15][16][17][18][19][20][21][22]31 Isner and Roberts28 were unable to demonstrate a relationship between the extent of human RV free wall infarction at autopsy and the severity of RV dysfunction before death, a finding consistent with results of RV free wall ablation studies in animals. "20 At autopsy, human RV infarction is virtually always associated with infarction of the diaphragmatic surface of the LV and posterior ventricular septum,2830 the infarct distribution resembling an inverted "T.' The frequency of RV dysfunction and RV free wall motion abnormalities associated with inferior infarction appears to be higher than the frequency of either scintigraphic or autopsy evidence of RV infarction, 8 4%48 although reversible ischemia of the RV free wall may explain some of this discrepancy.…”

Section: Discussionmentioning

confidence: 84%

Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Feneley¹,

Gavaghan²,

Baron³

et al. 1985

Circulation

128

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To determine whether left ventricular (LV) contraction contributes to the generation of right ventricular (RV) systolic pressure in humans, LV and RV pressures and their first derivative (dP/ dt) were recorded simultaneously with micromanometer-tipped catheters in 11 conscious subjects. Seven subjects had normal LV and coronary angiograms. Four subjects had moderate LV dysfunction (resting ejection fraction 0.40 to 0.50), and three of these had coronary artery disease. During normal sinus rhythm, LV contraction slightly preceded RV contraction (mean 20 msec), and LV and RV dP/dt recordings showed single positive systolic peaks that were coincident. During endocardial pacing of the RV free wall, RV contraction preceded LV contraction (mean 23 msec) and two systolic RV dP/dt peaks were recorded, the first (peak I) occurring significantly before (mean + SD = 67 23 msec, p < .01), and the second (peak II) coincident with the single systolic LV dP/dt peak. RV ectopic beats produced a similar RV dP/dt pattern, with peak I occurring 63 ± 1 1 msec (p < .01 ) before, and peak II coincident with the single LV dP/dt peak. Conversely, during LV ectopic beats, LV contraction preceded RV contraction (mean 63 msec) and two systolic RV dP/dt peaks were recorded, but peak I was coincident with the single LV dP/dt peak, while peak IL occurred significantly later (63 + 26 msec, p < .01). In two subjects right bundle branch block produced similar findings. In three subjects left bundle branch block produced little ventricular asynchrony (mean 14 msec), but did delay the development of peak LV dP/dt after LV contraction. In this situation, the secondary RV dP/dt peak (peak LI) followed the onset of LV contraction but preceded peak LV dP/dt. These findings suggest that LV contraction contributes to the generation of RV systolic pressure via the mechanical coupling of the ventricles, a contribution usually masked by the near synchrony of LV and RV contraction. RV systolic dysfunction might result, therefore, if the effective coupling of ventricular contraction were impaired. Circulation 71, No. 3, 473-480, 1985. THE LEFT VENTRICLE (LV) and the right ventricle (RV) are anatomically conjoined, and thus mechanically coupled, within the pericardium. '

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Section: Discussionmentioning

confidence: 84%

Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Feneley¹,

Gavaghan²,

Baron³

et al. 1985

Circulation

128

View full text Add to dashboard Cite

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“…The LV can contribute directly to RV contractility via mechanical coupling of the ventricles, inasmuch as continuity of the RV free wall with the LV myocardium permits the transmission of forces generated by LV contraction (7). This is supported by studies showing that 1) surgical replacement of the RV free wall with a prosthetic patch has little effect on RV dP/dt (50,52), 2) alteration of LV free wall function directly affects RV developed pressure (49), and 3) one of the peaks of RV dP/dt coincides with the peak of LV dP/dt (13,14,17,38). In our study, RV dP/dt max was linearly related to A PP in control and RVPO (Fig.…”

Section: Discussionmentioning

confidence: 88%

Effects of sequential biventricular pacing during acute right ventricular pressure overload

Quinn

Berberian

Cabreriza

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Temporary sequential biventricular pacing (BiVP) is a promising treatment for postoperative cardiac dysfunction, but the mechanism for improvement in right ventricular (RV) dysfunction is not understood. In the present study, cardiac output (CO) was optimized by sequential BiVP in six anesthetized, open-chest pigs during control and acute RV pressure overload (RVPO). Ventricular contractility was assessed by the maximum rate of increase of ventricular pressure (dP/dt max). Mechanical interventricular synchrony was measured by the area of the normalized RV-left ventricular (LV) pressure diagram (A PP ). Positive A PP indicates RV pressure preceding LV pressure, whereas zero indicates complete synchrony. In the control state, CO was maximized with nearly simultaneous stimulation of the RV and LV, which increased RV (P ϭ 0.006) and LV dP/dt max (P ϭ 0.002). During RVPO, CO was maximized with RV-first pacing, which increased RV dP/dt max (P ϭ 0.007), but did not affect LV dP/dtmax, and decreased the left-to-right, end-diastolic pressure gradient (P ϭ 0.023). Percent increase of RV dP/dt max was greater than LV dP/dtmax (P ϭ 0.014). There were no increases in end-diastolic pressure to account for increases in dP/dt max. In control and RVPO, RV dP/dtmax was linearly related to A PP (r ϭ 0.779, P Ͻ 0.001). The relation of CO to APP was curvilinear, with a peak in CO with positive A PP in the control state (P ϭ 0.004) and with A PP approaching zero during RVPO (P ϭ 0.001). These observations imply that, in our model, BiVP optimization improves CO by augmenting RV contractility. This is mediated by changes in mechanical interventricular synchrony. Afterload increases during RVPO exaggerate this effect, making CO critically dependent on simultaneous pressure generation in the RV and LV, with support of RV contractility by transmission of LV pressure across the interventricular septum. ventricular mechanics; interventricular synchrony; cardiac output; perioperative pacing; cardiac resynchronization therapy BIVENTRICULAR PACING (BiVP), or cardiac resynchronization therapy, is an important evolving therapeutic modality for congestive heart failure, reversing intraventricular conduction delay and left ventricular (LV) dysfunction intrinsic to dilated cardiomyopathy (2). In addition to long-term benefits for cardiac function and geometry in patients with various forms of chronic heart failure, BiVP is associated with acute improvements in ventricular systolic and diastolic function, inter-and intraventricular synchrony, and cardiac output (CO), with no cost to energy consumption (2). These acute benefits of BiVP suggest its possible value as an adjunct to the treatment of LV or right ventricular (RV) dysfunction after cardiac surgery. Although its use for perioperative management has not been carefully evaluated, initial studies have shown the utility of temporary BiVP after surgery for acquired (19, 56) and congenital (27, 40, 47) heart disease.Studies investigating sequential BiVP by alteration of the interventricular pacin...

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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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Influence of Left Ventricular Isovolumic Pressure Upon Right Ventricular Pressure Transients

Cited by 65 publications

References 17 publications

Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Effects of sequential biventricular pacing during acute right ventricular pressure overload

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

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