P5595Non-invasive atrial work in the differential diagnosis of pre-capillary and post-capillary pulmonary hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A E Vijiiac ◽  
S Iancovici ◽  
A Scarlatescu ◽  
A Deaconu ◽  
M Dorobantu
Keyword(s):  
Pulmonary Hypertension ◽  
Differential Diagnosis ◽  
Left Atrial ◽  
Roc Analysis ◽  
Vena Cava ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Atrial Volume ◽  
The Right

Abstract Background Right heart catheterization (RHC) is the gold standard for the diagnosis of pulmonary hypertension (PH) and for the discrimination of pre-capillary from post-capillary PH, but it is an invasive method with high costs and limited availability. While echocardiography is widely used in the evaluation of patients with PH, no algorithm has been validated to discriminate between the various forms of PH. Purpose We aimed to assess the differences in echocardiographically-derived atrial work between patients with different forms of PH. Methods We included 80 patients in our study, which were divided in two groups. The pre-capillary group consisted of 28 patients with pulmonary arterial hypertension confirmed at RHC. The post-capillary group consisted of 52 patients with PH and severe left heart disease. All patients underwent transthoracic echocardiography. Atrial work is defined as the product between atrial volume and atrial pressure; for the right atrium, we estimated atrial pressure from the inferior vena cava diameter and change with respiration; for the left atrium, we used thetransmitral E-wave/ septal mitral annular Doppler Tissue Imaging e'-wave ratio (E/e') as a surrogate for atrial pressure and we defined left atrial work as E/e' × left atrial volume. Results The mean age was 54±14 years in the pre-capillary group and 71±13 years in the post-capillary group (p<0.001). Among the patients in the post-capillary group, 36 (69%) had severe left ventricular systolic dysfunction (mean ejection fraction=23±8%) and 16 (31%) had severe aortic stenosis. The right atrial work was significantly higher in the pre-capillary group: 1089±1105 vs. 382±508 in the post-capillary group (p=0.004). Using receiver operating characteristic (ROC) analysis, a cut-off value of 289.5 provided fair discrimination (area under the curve [AUC] = 0.762) between the two groups (sensitivity=67%, specificity=67%). The left atrial work was significantly lower in the pre-capillary group: 392±206 vs. 1907±1072 in the post-capillary group (p<0.001). Using ROC analysis, a cut-off value of 764 provided excellent discrimination (AUC=0.980) between the two groups (sensitivity=95%, specificity=96%). There was a moderate positive correlation correlation between right atrial work and left atrial work in the post-capillary group (r=0.60, p<0.001), but no significant correlation in the pre-capillary group (p=0.84). Conclusion Echocardiographically-derived atrial work, both right and left, differ significantly between pre-capillary and post-capillary PH. These two simple echocardiographic parameters might guide the differential diagnosis of PH and potentially reduce the need for RHC, should they be further validated. Acknowledgement/Funding This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF

Effect of loading right atrial and ventricular receptors on stimulated AVP, ACTH, and renin secretion in awake dogs

1995 ◽  
Vol 268 (4) ◽  
pp. R1069-R1077 ◽  
Author(s):  
L. J. Andersen ◽  
J. L. Andersen ◽  
T. N. Thrasher ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Mean Arterial Pressure ◽  
Left Atrial ◽  
Adrenocorticotropic Hormone ◽  
Inferior Vena ◽  
Vena Cava ◽  
Plasma Renin ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Heart ◽  
The Right

The goal of this study was to test the hypothesis that increasing or decreasing the load on baroreceptors in the right heart influenced the secretion of arginine vasopressin (AVP), adrenocorticotropic hormone (ACTH), and renin during a state of sustained arterial hypotension. The hypothesis was tested in chronically instrumented conscious dogs prepared with inflatable cuffs around the pulmonary artery (PA) and the thoracic inferior vena cava (IVC). In one protocol (n = 5), mean arterial pressure was reduced 10 or 20% below control by constriction of the PA, a maneuver that caused a fall in left atrial pressure (LAP) and an increase in right atrial pressure (RAP). Plasma AVP, ACTH, atrial natriuretic peptide (ANP), and plasma renin activity (PRA) all increased (P < 0.05) in response to constriction of the PA. Reducing RAP to control by constriction of the IVC during maintained constriction of the PA had no effect on MAP, LAP, plasma AVP, ACTH, or PRA, but plasma ANP fell significantly. In a separate protocol (n = 4), constriction of the IVC was used to reduce MAP 10 or 20% below control, and this led to significant decreases in both LAP and RAP and increases in plasma AVP, ACTH, and PRA. RAP was then increased above control by constriction of the PA without altering either MAP or LAP. Raising RAP from a level that was 6.3 +/- 1.3 mmHg below control to 3.5 +/- 1.0 mmHg above control had no effect on plasma AVP, ACTH, or PRA.(ABSTRACT TRUNCATED AT 250 WORDS)

Control of atrial natriuretic factor by right and left atrial distension in pregnant sheep

1995 ◽  
Vol 268 (6) ◽  
pp. R1411-R1417
Author(s):  
D. Javeshghani ◽  
S. Mukaddam-Daher ◽  
L. Fan ◽  
Z. Guan ◽  
J. Gutkowska ◽  
...  
Keyword(s):  
Atrial Natriuretic Factor ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Natriuretic Factor ◽  
Pregnant Sheep ◽  
Vascular Catheters ◽  
The Right ◽  
Left Atrial Distension ◽  
Atrial Natriuretic

Previous studies of the atrial stretch-atrial natriuretic factor (ANF) relationship during pregnancy have employed volume expansion and measured only right atrial pressure (RAP). Consequently, we studied nonpregnant (n = 7) and 115- to 125-day pregnant (n = 7) sheep and assessed the ANF response to changes of RAP and left atrial pressure (LAP) induced by graded balloon inflation. Ewes prepared with vascular catheters and atrial balloons were studied after recovery from preparatory surgical procedures. The basal levels of mean arterial pressure (MAP, 83 +/- 3 mmHg), RAP (2.1 +/- 0.7 mmHg), LAP (4.7 +/- 0.9 mmHg), and heart rate (HR, 102 +/- 6 beats/min) were similar in nonpregnant and pregnant sheep. Pregnancy also resulted in elevation of ANF concentration from 25 +/- 6 to 57 +/- 4 fmol/ml. With right atrial distension, the RAP-ANF relationships were similar in both nonpregnant and pregnant sheep, with a 10-mmHg increase in RAP increasing ANF by an average of 95 +/- 9 fmol/ml. In nonpregnant sheep, the LAP-ANF relationship was more responsive than RAP-ANF because a 10-mmHg increase in LAP resulted in a 193 +/- 10 fmol/ml increase in ANF. Moreover, during pregnancy, the LAP-ANF relationship was significantly more sensitive because a 10-mmHg increase in LAP resulted in a 433 +/- 15 fmol/ml elevation of ANF. These data demonstrate that plasma ANF levels are more responsive to distension of the left atria than to the right. More importantly, the ANF response to left, but not right, atrial distension is enhanced by pregnancy.

Role of right heart receptors in the control of renin, vasopressin, and cortisol secretion in dogs

1992 ◽  
Vol 263 (5) ◽  
pp. R1071-R1077 ◽  
Author(s):  
D. H. Carr ◽  
D. B. Jennings ◽  
T. N. Thrasher ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Plasma Renin ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Heart ◽  
Hormonal Responses ◽  
The Right ◽  
Maximal Reduction

We have reported that increased left heart pressure inhibits increases in plasma renin activity (PRA), arginine vasopressin (AVP), and cortisol during arterial hypotension. The goal of this study was to determine whether increases in right heart pressure also inhibited hormonal responses to hypotension. Seven dogs were chronically instrumented with inflatable cuffs around the ascending aorta (AA), the pulmonary artery (PA), and the thoracic inferior vena cava (IVC), as well as with catheters in both atria, the abdominal aorta, and vena cava. The IVC, the PA, and the AA cuffs were inflated on different days to cause step reductions in mean arterial pressure (MAP) of 5, 10, 20, and 30% below control MAP. Graded constriction of the AA caused large increases in left atrial pressure and plasma atrial natriuretic peptide (ANP), but had no effect on plasma AVP or cortisol and caused only a small increase in PRA at the maximal reduction of MAP. Constriction of the IVC reduced both atrial pressures and plasma ANP, but stimulated increases in PRA, AVP, and cortisol. Constriction of the PA increased right atrial pressure and plasma ANP and caused increases in plasma AVP and cortisol that were similar to responses during IVC constriction, but the PRA response was only half (P < 0.05). These results indicate that increasing pressure on the right side of the heart can attenuate the PRA response to hypotension, and suggest that the inhibition is mediated by the rise in plasma ANP.

scholarly journals Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

2018 ◽  
Vol 35 (11) ◽  
pp. 1729-1735 ◽  
Author(s):  
Manu M. Mysore ◽  
Kenneth C. Bilchick ◽  
Priscilla Ababio ◽  
Benjamin K. Ruth ◽  
William C. Harding ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Index Ratio

Reference sites not influenced by hydrostatic pressure for right and left atrial pressures

1964 ◽  
Vol 207 (2) ◽  
pp. 357-360 ◽  
Author(s):  
George G. Armstrong ◽  
John C. Hancock
Keyword(s):  
Hydrostatic Pressure ◽  
Reference Point ◽  
Left Atrial ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Right Atrial ◽  
Lateral Border ◽  
Zero Reference ◽  
The Right ◽  
Made In

Simultaneous recordings of left and right atrial pressures made in dogs being rotated into all positions in space allowed the location of rotational axes where right or left atrial pressure became independent of hydrostatic pressure. Utilization of these axes as zero reference levels made possible the measurement of right or left atrial pressure without the influence of hydrostatic factors. The right zero reference point lay 62.8% of the distance from the manubrium to the xiphoid, 61.2% of the posterior to anterior thoracic diameter, and 47.7% of the greatest transverse thoracic diameter as measured from the right lateral border. The left atrial zero reference point lay 62.1% of the manubrium to xiphoid distance, 57.2% of the posterior to anterior diameter of thorax, and 53.0% of the greatest transverse thoracic diameter as measured from the right lateral border. When referred to the anatomy of the dog, these points lay in the immediate vicinity of the right and left atrioventricular valves, respectively.

scholarly journals Pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension. An echographic study

2017 ◽  
Vol 90 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Adriana V. Gurghean ◽  
Ioana A. Tudor
Keyword(s):  
Pulmonary Hypertension ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Hepatic Cirrhosis ◽  
Right Atrial ◽  
Atrial Volume ◽  
Hyperdynamic State ◽  
The Right ◽  
Right Atrial Volume

Aim of the study. The aim of the study is to determine the frequency of pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension, to determine the possibility of an accurate ultrasound diagnosis of the characteristics of this complication.Method. 347 patients with liver cirrhosis consecutively hospitalized at Coltea Clinical Hospital were screened. 61 were excluded because of other possible causes of portal or pulmonary hypertension. All patients were investigated clinically and by abdominal and cardiac ultrasonography.Results. 0f the remaining 286 patients, 116 had portal hypertension, 27 of them (23%) having pulmonary hypertension. In this group we found a higher cardiac index and right atrial volume, higher pressures in the right atrium, suggesting a hyperdynamic state. Porto-pulmonary hypertension was found in only one patient.Conclusion. Echocardiography permits characterization of patients with cirrhosis and portal hypertension

Progressive changes in cardiovascular function after unilateral heart irradiation

1964 ◽  
Vol 206 (2) ◽  
pp. 289-293 ◽  
Author(s):  
H. L. Stone ◽  
V. S. Bishop ◽  
A. C. Guyton
Keyword(s):  
Left Ventricle ◽  
Arterial Pressure ◽  
Blood Volume ◽  
Pulse Rate ◽  
Left Atrial ◽  
Pressure Pulse ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Before And After ◽  
The Right

Chronic heart failure was produced by giving 20,000 r Co60 irradiation to either the right or left ventricle in nine closed-chest animals. Measurements of right and left atrial pressures, arterial pressure, pulse rate, body weight, and blood volume were made before and after irradiation. The right and left atrial pressures rose progressively until death in three animals irradiated on the right side. In six animals irradiated on the left side, the left atrial pressure rose progressively, but the right atrial pressure either did not rise or rose only during the latter stages of failure. Declining arterial pressure and increasing pulse rate were common to both groups. Increases in blood volume were observed in all animals, but this increase was only significant in the group irradiated on the left side. At autopsy, 70–100% of the right ventricular muscle was damaged in dogs irradiated on the right side, and 40–70% of the left ventricle in dogs irradiated on the left side. Hydrothorax and liver congestion were found in the right-sided group and pulmonary congestion in the left-sided group.

Right Atrial to Left Atrial Volume Index Ratio is Associated with Mortality in Patients with Pulmonary Hypertension

2017 ◽  
Vol 23 (8) ◽  
pp. S48
Author(s):  
Manu Mysore ◽  
Kenneth Bilchick ◽  
Benjamin Ruth ◽  
William Harding ◽  
Christiana Jeukeng ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Index Ratio

Plasma Natriuretic Peptides and Cardiac Volume during Acute Changes in Intravascular Volume in Haemodialysis Patients

1994 ◽  
Vol 87 (6) ◽  
pp. 679-684 ◽  
Author(s):  
John C. Corboy ◽  
Robert J. Walker ◽  
Mark B. Simmonds ◽  
Gerard T. Wilkins ◽  
A. Mark Richards ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Natriuretic Peptides ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Right Atrial ◽  
Atrial Volume ◽  
Ventricular Volumes ◽  
Acute Changes

1. Plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptides (BNP) were measured, along with left and right atrial and left ventricular volumes, in eight patients with chronic renal failure before and after the removal of 2.1 ± 0.61 of fluid by ultrafiltration and again during volume repletion with intravenous sodium chloride solution (150 mmol/l saline) to restore body weight plus 0.5 kg. 2. Baseline levels of ANP (46.0 ± 7.5 pmol/l) and BNP (22.0 ± 4.4 pmol/l) were elevated above normal. There was a significant reduction in plasma ANP (26.5 ± 4.7 pmol/l, P < 0.05) and BNP (19.1 ± 4.9 pmol/l, P < 0.05)) following ultrafiltration. Changes in plasma ANP during ultrafiltration correlated significantly with changes in left atrial volume (r = 0.643, P < 0.05). 3. During volume repletion there was an exaggerated release of ANP (mean level post repletion 71.3 ± 20.8 pmol/l) which was not paralleled by changes in BNP. Changes in BNP were small, showing no correlation with atrial or ventricular volumes during either ultrafiltration or volume repletion. 4. These findings indicate that in chronic renal failure without left ventricular dysfunction, moderate acute changes in volume status elict only small immediate responses in plasma BNP. Changes in plasma ANP are greater than BNP and more responsive to changes in left atrial volume.

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