Pressure and Volume Loading of the Right Ventricle Have Opposite Effects on Left Ventricular Ejection Fraction

Louie, Eric K.; Lin, Steve S.; Reynertson, Sandra I.; Brundage, Bruce H.; Levitsky, Sidney; Rich, Stuart

doi:10.1161/01.cir.92.4.819

Cited by 153 publications

(102 citation statements)

References 19 publications

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“…It is well known that diastolic dysfunction, particularly in the early phase of diastole, is the most common type of LV dysfunction seen in patients with chronic PH [25]. This impairment of early relaxation could be explained by different mechanisms.…”

Section: Discussionmentioning

confidence: 99%

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

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2007

Eur Respir J

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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: 99%

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

Papadopoulos¹,

Pitsiou²,

Karamitsos³

et al. 2007

Eur Respir J

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“…2,3,13 End-diastolic and end-systolic crosssectional areas (cm 2 ) in the short-axis view, both at the mitral annulus (MA ED and MA ES ) and the mid-papillary (PA ED and PA ES ) levels, and LV length (cm), end-diastolic (L ED ) and end-systolic (L ES ), in the long-axis view were measured. V ED (ml), V ES (ml), and ejection fraction (EF) (%) were calculated by the equations shown below.…”

Section: Pulsed Doppler and 2d Echocardiographic Examinationmentioning

confidence: 99%

“…R ight ventricular volume overload (RVVO) is often associated with tricuspid regurgitation [1][2][3][4][5][6][7] or a left-to-right shunt at the atrial level. 8 -11 Long-lasting RVVO gradually induces right ventricular (RV) and right atrial dilatation, leading to congestive RV failure.…”

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confidence: 99%

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Total Right Ventricular Exclusion Improves Left Ventricular Function in Patients With End-Stage Congestive Right Ventricular Failure

et al. 2003

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Background-We developed a total right ventricular (RV) exclusion procedure for the treatment of isolated congestive RV failure. The objective of the present study was to elucidate the effects of a complete removal of RV volume overload (RVVO) on the surgically created single left ventricle (LV). Methods and Results-Three adults (2 arrhythmogenic RV dysplasia, 1 Ebstein) and 5 children (all Ebstein) in NYHA class IV underwent the procedure. The RV free wall was resected from the heart, and the tricuspid orifice was closed. Pulmonary blood supply was obtained by a cavopulmonary connection in 6 patients and a systemic-pulmonary shunt in 2. The LV function was evaluated by 2-dimensional echocardiography 1 month after the surgery. All patients are alive. The paradoxical movement of the interventricular septum and geometry of the LV expressed by its eccentricity (2.

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“…A mechanical interaction of heart chambers in diastole has been demonstrated experimentally and clinically; [1][2][3][4] this interaction is particularly important in patients with heart failure, explaining why stroke volume is maintained or increases in some patients when pulmonary capillary wedge pressure is reduced with vasodilator therapy. Volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.…”

Section: Introductionmentioning

confidence: 99%

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

Pepi

Tamborini

Maltagliati

et al. 2003

Clinical Cardiology

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SummaryBackground: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction.Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40˚ of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study.Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic for-

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Pressure and Volume Loading of the Right Ventricle Have Opposite Effects on Left Ventricular Ejection Fraction

Cited by 153 publications

References 19 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

Total Right Ventricular Exclusion Improves Left Ventricular Function in Patients With End-Stage Congestive Right Ventricular Failure

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

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