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)

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 Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sneha R. Gadi ◽  
Benjamin K. Ruth ◽  
Alan Johnson ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Unusual Presentation ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Common Phenomenon ◽  
Right Heart

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.

scholarly journals Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

2019 ◽  
Vol 47 (7) ◽  
pp. 3465-3474
Author(s):  
Guangze Luo ◽  
Hongrui Pan ◽  
Jiaxue Bi ◽  
Yudong Luo ◽  
Jiechang Zhu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Iliac Vein ◽  
Right Atrial ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
The Right

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

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

scholarly journals P344 Echocardiography right atrial area and inferior vena cava diameter interest to predict right atrial pressure in pulmonary arterial hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fauvel ◽  
O Raitiere ◽  
J Burdeau ◽  
N Si Belkacem ◽  
F Bauer
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Inferior Vena ◽  
Vena Cava ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
Right Atrial Area ◽  
Atrial Area

Abstract Background Risk stratification in Pulmonary Arterial Hypertension (PAH) is based on multiparametric approach including invasive measurement of invasive right atrial pressure (RAP) by right heart catheterization (RHC). Therefore, following 2015 ESC/ERS pulmonary hypertension (PH) guidelines, RHC are frequently repeated every 4 to 6 months until RAP &lt;8 mmHg. Purpose To explore the interest of right atrial area (RAA) and inferior vena cava (IVC) diameter measured by transthoracic echocardiography, as a surrogate for right atrial preload to detect RAP &lt;8 mm Hg and avoid repeated RHC in PAH patients. Methods From a prospective single PAH referral center, we have included all patients with a diagnosis of PAH (confirmed by PH team). During the follow up, transthoracic echocardiography and a RHC was performed on the same day. RAA (cm2) was measured in the apical four-chamber view, at end-systole, just prior to tricuspid valve opening, excluding the area under tricuspid valve annulus. In the subcostal view, at 1.0 to 2.0 cm from the junction with the right atrium, IVC diameter (mm) was reported. Both RAA and IVC were compared to RAP. Results 97 PAH patients were included (35 males, mean age 65 ± 16y, mean arterial pressure was 45 ± 16 mmHg, cardiac index 3.0 ± 1.0 l/min/m² and right atrial pressure was 7.6 ± 4.7 mm Hg). Both IVC diameter and RAA averaged 18.1 ± 6.3mm and 22.5 ± 8.2 mm by echocardiography, respectively. IVC diameter and RAA had a significant but weak correlation with right atrial pressure &lt;8 mmHg measured by RHC (r = 0.42, p &lt; 0.01 and r = 0.41, p &lt; 0.01, respectively). Targeting a good specificity (Sp = 0.75), ROC curves analysis identified 10 mm for the IVC diameter and 20 cm² for RAA if IVC diameter was &gt; 10 but &lt; 20 mm to predict RAP &lt;8 mmHg (area under the curve = 0.72). Thus, in our cohort, 40% could have been followed-up non-invasively by echocardiography with IVC diameter ≤10 mm or &gt;10 but &lt;20 mm with RAA ≤20 cm² with only 2% of misclassification. For the remaining 58% unclassified PAH patients out of these echocardiographic ranges, RHC would have been requested. Conclusion In a cohort of PAH patients, targeting a low risk clinical worsening or death (identified by RAP &lt;8 mmHg in RHC), echocardiography, with the use of IVC diameter ≤10 mm or &gt;10 but &lt;20 mm with RAA ≤20 cm², right heart catheterisation may be avoided in 40% of cases with extremely low misclassification.

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.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

scholarly journals Moderated Posters: Imaging of the right heart - What is new?P814Prognostic value of parameters of pulmonary artery stiffness in patients with pulmonary hypertension receiving specific vasodilator therapyP815Reconsidering of inferior vena cava parameters for estimating right atrial pressure: a comparative simultaneous ultrasound-catheterization studyP816Pulmonary hypertension is the main factor echocardiography to predicting mortality in medium and long term in a cohort of patients with heart failureP817Normal values for 3D-right atrial volumes : results from the SKIPOGH-II population studyP818Assessment of right ventricular function by free wall longitudinal strain in organic mitral regurgitationP819Importance of radial dysfunction to determine the impairment of right ventricular ejection fraction in patients with pulmonary hypertensionP820Influence of tricuspid regurgitation severity on non-invasive assessment of right heart hemodynamics: a simultaneous echocardiography-catheterization studyP821Right ventricular failure following ventricular assist device implant: systematic review and meta-analysis of clinical and echocardiographic predictors

2016 ◽  
Vol 17 (suppl 2) ◽  
pp. ii161-ii163
Author(s):  
R. Enache ◽  
N. Sawada ◽  
L. Molina Ferragut ◽  
P. Monney ◽  
A. Jobbe Duval ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Meta Analysis ◽  
Vena Cava ◽  
Right Ventricular Ejection Fraction ◽  
Right Atrial ◽  
Right Heart ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction ◽  
Artery Stiffness ◽  
The Right

Good Predictor of Right Atrial Pressure in the Inferior Vena Cava Parameters by 2-Dimensional Echocardiogrphy

2017 ◽  
Vol 23 (10) ◽  
pp. S39
Author(s):  
Akiko Idemoto ◽  
Haruhiko Abe ◽  
Kaori Yasumura ◽  
Hiroki Nishida ◽  
Taishi Kato ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Good Predictor ◽  
Inferior Vena ◽  
Vena Cava ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure

Left heart and arterial baroreceptors interact in control of plasma vasopressin, renin, and cortisol in awake dogs

1994 ◽  
Vol 266 (3) ◽  
pp. R879-R888 ◽  
Author(s):  
J. L. Andersen ◽  
L. J. Andersen ◽  
T. N. Thrasher ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Vena Cava ◽  
Plasma Renin ◽  
Significant Rise ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Arterial Hypotension ◽  
Left Heart ◽  
Arterial Baroreceptors ◽  
Plasma Arginine ◽  
Stimulation Of

Arterial hypotension induced by constriction of the ascending aorta (AA) causes increases in left atrial pressure (LAP) and plasma atrial natriuretic peptide (ANP), but no change in plasma arginine vasopressin (AVP), plasma renin activity (PRA), or cortisol. In the present study, we tested the hypothesis that the rise in left heart pressure during constriction of the AA suppressed the stimulation of AVP, renin, and cortisol secretion in response to arterial hypotension. Dogs were prepared with inflatable cuffs around the AA, the pulmonary artery (PA), and the thoracic inferior vena cava (IVC) and with catheters in the left and right atria and abdominal aorta. In one series of experiments, the AA was constricted to lower mean arterial pressure (MAP) 10 or 20% below control for 15 min. Then, either the PA or the IVC was constricted to bring LAP back to control levels but without altering the degree of arterial hypotension. Constriction of the AA alone led to significant increases in LAP and plasma ANP but no change in plasma AVP, cortisol, or PRA. Reducing LAP to control levels by constriction of either the PA or IVC led to significant and similar increases in plasma AVP, cortisol, and PRA. Plasma ANP fell significantly 10 min after LAP was normalized by constriction of the IVC but not when LAP was normalized by constriction of the PA, because PA constriction caused a significant rise in right atrial pressure that stimulated ANP secretion. The increases in plasma AVP and PRA after normalizing LAP by constriction of the PA were compared with the increases obtained during identical falls in MAP induced by constriction of the IVC alone, a maneuver that lowers LAP below control. The increases in plasma AVP in the two conditions were identical, indicating that the stimulation of left heart baroreceptors alone can account for the suppression of AVP secretion in response to unloading arterial baroreceptors. In contrast, there was a greater rise in PRA during hypotension caused by constriction of the IVC alone compared with the condition in which LAP was normalized but plasma ANP remained elevated. This suggests that increased left heart pressure inhibits renin secretion in response to arterial hypotension by reflex mechanisms and by increased plasma ANP concentration.

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