Performance of the failing and nonfailing right ventricle of patients with pulmonary hypertension

Stein, Paul D.; Sabbah, Hani N.; Anbe, Daniel T.; Marzilli, Mario

doi:10.1016/0002-9149(79)90168-1

Cited by 80 publications

(28 citation statements)

References 24 publications

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“…As demonstrated by numerous studies, RV dP/dt max is significantly affected by loading conditions and cannot be used as a reliable index of contractility. 66 It may, however, be useful in assessing directional change in response to therapy.…”

Section: Selected Indices Of Rv Contractilitymentioning

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: Selected Indices Of Rv Contractilitymentioning

confidence: 99%

Right Ventricular Function in Cardiovascular Disease, Part I

et al. 2008

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“…If one or more feature identified, PH may be present RA volume [8,20] RV myocardial performance index [8,[25][26][27] Tissue Doppler index of RV free wall [7,8,31,32,34] Eccentricity index (end-systolic and diastolic) [8,43,44] Cardiac output [46,47] Congenital heart disease (in particular, exclude pulmonary stenosis)…”

Section: Causes Of Phmentioning

confidence: 99%

“…Valvular heart disease (in particular, mitral valve) LV systolic/diastolic dysfunction Pulmonary vascular resistance [46,47] Consider right heart assessment protocol Assess associated causes RV ≥1/2 LV from PLAX [11] RVOT AT <105 ms [8,15,16] RV IVRT >75 ms [8,31,32] IVC >20 mm and <50% inspiratory collapse [8] TAPSE <20 mm [8, 28-30, 33, 53, 54] End-diastolic PRV >1.0 m . s -1 [14,17] TRV ≥2.6 m .…”

Section: Causes Of Phmentioning

confidence: 99%

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Howard¹,

Grapsa²,

Dawson³

et al. 2012

European Respiratory Review

158

157

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Patients with suspected pulmonary hypertension (PH) should be evaluated using a multimodality approach to ensure that they receive a correct diagnosis. The series of investigations required includes clinical evaluation, noninvasive imaging techniques and right heart catheterisation (considered to be the ''gold standard'' for the diagnosis of PH). Current guidelines recommend that a detailed echocardiographic assessment is performed in all patients with suspected PH.In this review we summarise a protocol adopted by the National Pulmonary Hypertension Centres of UK and Ireland and approved by the British Society of Echocardiography for the evaluation of these patients. The views and measurements described are recommended for diagnosis, assisting in prognosis and providing a noninvasive means of following disease progression or response to therapy.

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“…In the case of typical TR, RAP rises throughout RV systole, with pressure regurgitation waves. In early stages of PH, the RV contractility is increased and the peak rate of RV pressure rise may be increased by up to 10 times the normal value [66]. Analysis of RV waveform in more severe forms of the disease reveals RV systolic dysfunction with depressed upstroke and delayed relaxation.…”

Section: Right Heart Functionmentioning

confidence: 99%

Haemodynamic evaluation of pulmonary hypertension

Chemla¹,

Castelain²,

Hervé³

et al. 2002

European Respiratory Journal

302

185

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Haemodynamic evaluation of pulmonary hypertension. D. Chemla, V. Castelain, P. Hervé, Y. Lecarpentier, S. Brimioulle. #ERS Journals Ltd 2002. ABSTRACT: Pulmonary hypertension is characterised by the chronic elevation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) leading to right ventricular enlargement and hypertrophy. Pulmonary hypertension may result from respiratory and cardiac diseases, the most severe forms occurring in thromboembolic and primary pulmonary hypertension.Pulmonary hypertension is most often defined as a mean PAP w25 mmHg at rest or w30 mmHg during exercise, the pressure being measured invasively with a pulmonary artery catheter. Doppler echocardiography allows serial, noninvasive follow-up of PAPs and right heart function. When the adaptive mechanisms of right ventricular dilatation and hypertrophy cannot compensate for the haemodynamic burden, right heart failure occurs and is associated with poor prognosis.The haemodynamic profile is the major determinant of prognosis. In both primary and secondary pulmonary hypertension, special attention must be paid to the assessment of pulmonary vascular resistance index (PVRI), right heart function and pulmonary vasodilatory reserve.Recent studies have stressed the prognostic values of exercise capacity (6-min walk test), right atrial pressure, stroke index and vasodilator challenge responses, as well as an interest in new imaging techniques and natriuretic peptide determinations. Overall, careful haemodynamic evaluation may optimise new diagnostic and therapeutic strategies in pulmonary hypertension.

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Performance of the failing and nonfailing right ventricle of patients with pulmonary hypertension

Cited by 80 publications

References 24 publications

Right Ventricular Function in Cardiovascular Disease, Part I

Right Ventricular Function in Cardiovascular Disease, Part I

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Haemodynamic evaluation of pulmonary hypertension

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