Pulmonary artery compliance: its role in right ventricular-arterial coupling

Fourie, Paula; Coetzee, André; Bolliger, Chris T.

doi:10.1093/cvr/26.9.839

Cited by 111 publications

(89 citation statements)

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“…30 In control patients, the ratio of E max to E a was 1.9, which is consistent with normal values previously reported in pigs and dogs and reflects a good matching of RV systolic properties to its afterload. 6,15,22 In contrast, in PHT patients, the ratio of E max to E a was significantly smaller, indicating an unfavorable coupling between the RV and pulmonary vascular system with inefficient mechanical work production. 6,22 This finding can explain, at least partially, the noted decreased RV pump performance.…”

Section: Physiological Aspects Of This Studymentioning

confidence: 89%

“…6,22 The efficiency of coupling between the RV and the PA system was defined as the ratio of E max to E a . 6,22 …”

Section: Va Couplingmentioning

confidence: 99%

“…1,2 Pressure-volume relations yield information about ventricular pump performance, mechanical interaction of the ventricle with the pulmonary vascular system, and the contractile state of the myocytes and thus may provide important insight into the pathophysiology of the pressure-loaded RV. [3][4][5][6][7] MRI analysis of RV and left ventricular (LV) volumes does not rely on geometrical assumption. 8 -10 MRI is widely considered the "gold standard" to assess ventricular pump function but is limited in its ability to determine cardiovascular pressures required for assessment of more loadindependent parameters of ventricular function.…”

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confidence: 99%

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Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

Küehne

Yilmaz²,

Steendijk³

et al. 2004

Circulation

325

125

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Background-The aims of this study were to validate MRI-derived right ventricular (RV) pressure-volume loops for assessment of RV myocardial contractility and then to apply this technique in patients with chronic RV pressure overload for assessment of myocardial contractility, ventricular pump function, and VA coupling. Methods and Results-Flow-directed catheters were guided under MR fluoroscopy (1.5 T) into the RV for invasive pressure measurements. Simultaneously, ventricular volumes and myocardial mass were assessed from cine MRI. From sampled data, RV pressure-volume loops were constructed, and maximal ventricular elastance indexed to myocardial mass (E max_i ) was derived by use of a single-beat estimation method. This MRI method was first validated in vivo (6 swine), with conductance techniques used as reference. Bland-Altman test showed good agreement between methods (E max_i ϭ5.1Ϯ0.5 versus 5.8Ϯ0.7 mm Hg · mL Ϫ1 · 100 g

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Section: Physiological Aspects Of This Studymentioning

confidence: 89%

“…6,22 The efficiency of coupling between the RV and the PA system was defined as the ratio of E max to E a . 6,22 …”

Section: Va Couplingmentioning

confidence: 99%

mentioning

confidence: 99%

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Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

Küehne

Yilmaz²,

Steendijk³

et al. 2004

Circulation

325

125

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“…Several authors suggest that it is uncoupling of RV resources from the pulmonary arterial load, rather than obstruction, that causes RV failure. 17,18 This is further evidence that fixed variables, such as obstruction index and pulmonary systolic pressure, are unable to predict morbidity, as they do not reflect RV-PA coupling. Added to the fact that calculation of the arterial obstruction index is difficult and time-consuming, the effectiveness of this index in the acute setting remains to be proven.…”

Section: Discussionmentioning

confidence: 87%

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Baptista

Santiago²,

Jorge

et al. 2013

Revista Portuguesa de Cardiologia

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Introduction: Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. Objectives: We compared the prognostic impact of MDCT-derived indices regarding mediumterm mortality in a population of intermediate-to high-risk PE patients, mostly treated by thrombolysis. Methods: Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. Results: Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Followup all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term allcause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60---0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. elsevier.pt, day 19/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 8 R. Baptista et al.Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE. © 2012 Sociedade Portuguesa de Cardiologia Published by Elsevier España, S.L. All rights reserved. Angiografia pulmonar por tomografia computadorizada em doentes com tromboembolia pumonar de médio a alto risco: avaliação diagnóstica e prognóstica num só exame Resumo Introdução: A angiografia pulmonar por tomografia computadorizada com contraste (angio-TC) é recomendada para o diagnóstico mas não para a estratificação de risco em doentes com tromboembolia pulmonar (TEP). Objectivos: Determinar o impacto prognóstico a médio-prazo de vários índices radiológicos obtidos na angio-TC em doentes com TEP de médio a alto risco, a maioria tratados com fibrinólise. Métodos: Estudaram-se 39 doentes admitidos numa unidade de cuidados intensivos por TEP, todos com angio-TC prévia realizada na urgência e seguiram-se durante 33 meses. Mediram-se as seguintes variáveis: razão entre os diâmetros do ventrículo direito e ventrículo esquerdo (índice VD/VE), índice de obstrução arterial, razão ente os diâmetros da artéria pulmonar e aorta e diâmetro da veia ázigos. Resultados: A idade média foi de 59,1 ± 19,6 anos; 80% dos doentes foram tratados com fibrinólise. Durante o período de seguimento clínico, a mortalidade foi 12,8%. Das variáveis analisadas, apenas o índice VD/...

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“…Ea, the ratio of end systolic pressure (PES)/stroke volume, is representative of arterial loading, while Ees is an indicator of ventricular end-systolic elastance. The ratio is used to index relative coupling between the heart and vascular system (12).…”

Section: Introductionmentioning

confidence: 99%

Prenatal nicotine exposure induces gender-associated left ventricular-arterial uncoupling in adult offspring

Wang

Ouyang

Huang

et al. 2012

Molecular Medicine Reports

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Abstract. Alterations in vascular or myocardial structure and function have been demonstrated in offspring subjected to prenatal nicotine exposure (PNE), however, limited data are available on how these changes interact. The present study assessed the hypothesis that prenatal nicotine exposure induced gender-specific alterations of left ventricular-arterial coupling indices in adult offspring. Female Sprague-Dawley rats were exposed to either nicotine (8 mg/kg/day) or saline via subcutaneous osmotic mini-pumps throughout gestation. Male and female offspring, aged 12 months, underwent non-invasive echocardiography and invasive left ventricular cannulation. Left ventricular-arterial coupling was analysed as the ratio of effective arterial elastance (Ea) to ventricular end-systolic elastance (Ees). The left ventricular myocardium and aorta were stained with hematoxylin and eosin and the myocardial cell cross-sectional area was calculated. Simultaneously, the ratio of medium thickness to internal diameter in the aorta and mesenteric artery was determined. The fibrosis component of left ventricle myocardium was analyzed by Sirius-red staining and further confirmed by hydroxyproline determination. The elastic properties of the aortic wall were analyzed by van Gieson staining. PNE caused significant increases in pulse pressure (56.36±7.41 vs. 50.16±4.94 mmHg; P<0.05) and left ventricular meridional wall stress (78.25±9.12 vs. 69.64±7.58 kdyne/cm 2 ; P<0.05) in male offspring compared with the control. Conversely, no similar effect was observed in female offspring. An elevated augmentation index was noted in male and female pups. Additionally, Ea/Ees was reduced in PNE males compared with control males, due to a disproportionate increase in Ees vs. Ea whereas in females, Ea/Ees did not differ significantly due to tandem increase in Ea and Ees. In addition, collagen cross-linking was markedly higher in male offspring, whereas it was unaltered in females compared with their respective controls. Fragmentation of the elastic network in the aorta and the increased ratio of medial thickness to internal diameter in the mesenteric artery were more evident in male offspring when compared with female offspring. PNE caused combined ventricular-arterial stiffening in male and female offspring, with lower Ea/Ees in males, while Ea/Ees was preserved in females. Enhanced collagen cross-linking in the myocardium, underdeveloped elastic fibers in the aorta and remodeled resistance vessels were associated with pathological ventricular arterial mismatching. The results of the present study indicated that male offspring were more susceptible to the development of ventricular and arterial dysfunction in response to PNE compared with female offspring.

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Pulmonary artery compliance: its role in right ventricular-arterial coupling

Cited by 111 publications

References 0 publications

Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops

One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography

Prenatal nicotine exposure induces gender-associated left ventricular-arterial uncoupling in adult offspring

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