Left ventricular effects on right ventricular developed pressure

1976 ◽  
Vol 41 (6) ◽  
pp. 925-930 ◽  
Author(s):  
W. P. Santamore ◽  
P. R. Lynch ◽  
J. L. Heckman ◽  
A. A. Bove ◽  
G. D. Meier
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Left Coronary Artery ◽  
Coronary Occlusion ◽  
Left Ventricular ◽  
Free Wall ◽  
Wall Function ◽  
Lv Volume ◽  
Developed Pressure ◽  
Rv Function

The possibility that left ventricular (LV) performance might affect right ventricular (RV) function through the myocardium was examined by using isolated, flow-perfused, paced rabbit hearts beating isovolumically. ReducingLV volume from its optimal volume to zero caused a 5.7% decrease (N = 10, Pless than 0.001) in right ventricular developed pressure (RVDP). Ligatingthe anterior ventricular branches of the left coronary artery which in the rabbit supply the LV free wall resulted in an additional 9.3% decrease in RVDP (N = 5, P = 0.05) within 3 min of ligation. Finally, cutting the LV free wall from the atrioventricular orifice to the apex (thereby preventing any developed LV free wall force during systole) caused a 45% further decrease in RVDP (N = 2, P less than 0.02). Cineradiographic study showed that the alterations in RVDP resulting from changes in LV volume and coronary occlusion correlated significantly (N = 5, P less than 0.01) with the magnitude ofseptal bulging into the RV cavity during systole. The results indicate thatalteration in LV free wall function and changes in LV volume can directly effect RVDP through the myocardium.

P1444 Occurrence and predictors of right ventricular dysfunction after pericardiocentesis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Matsutani ◽  
M Amano ◽  
C Izumi ◽  
M Baba ◽  
R Abe ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Longitudinal Strain ◽  
Linear Dimension ◽  
Left Ventricular ◽  
Lv Function ◽  
P Value ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Before And After ◽  
Rv Function

Abstract Background—The changes in cardiac function that occur after pericardiocentesis are unclear.Purpose—This study was performed to assess right ventricular (RV) and left ventricular (LV) function with echocardiography before and after pericardiocentesis. Method and Results—In total, 19 consecutive patients who underwent pericardiocentesis for more than moderate pericardial effusion were prospectively enrolled from August 2015 to October 2017. Comprehensive transthoracic echocardiography was performed before, immediately after (within 3 hours), and 1 day after pericardiocentesis to investigate the changes in RV and LV function. RV dysfunction is defined as meeting three of the four criteria: a TAPSE of <17 mm, an S’ of <9.5 cm, an FAC of <35%, and an RV free wall longitudinal strain >−20%. The mean age of all patients was 72.6 ± 12.2 years. The changes of echocardiographic parameters related to RV function are shown in Table. After pericardiocentesis, RV inflow and outflow diameters increased and the parameters of RV function significantly decreased. These abnormal values or RV dysfunction remained at 1 day after pericardiocentesis. Conversely, no parameters of LV function parameters changed after pericardiocentesis. Of 19 patients, 13 patients showed RV dysfunction immediately after pericardiocentesis and 6 patients did not. RV free wall longitudinal strain before pericardiocentesis was higher in patients with post-procedural RV dysfunction (−18.9 ± 3.6%) than in those without (−28.4 ± 6.3%). ROC analysis revealed that a RV free wall longitudinal strain cut-off value of −23.0% had a sensitivity of 100% and a specificity of 83.3% for predicting the occurrence of RV dysfunction after pericardiocentesis (AUC = 0.910). Conclusions—The occurrence of RV dysfunction after pericardiocentesis should be given more attention. Pre-existing RV dysfunction maybe related to the occurrence of RV dysfunction after pericardiocentesis. Changes in RV function before and after Before Immediately after One day after P−value Basal right ventricular linear dimension (mm) 32.8 ± 5.0 37.1 ± 4.4† 33.6 ± 5.4 0.028 Mid-cavity right ventricular linear dimension (mm) 34.5 ± 4.6 38.8 ± 5.3† 37.0 ± 5.6 0.0504 Proximal right ventricular outflow diameter (mm) 30.2 ± 4.0 33.9 ± 3.5† 31.4 ± 3.9 0.014 TAPSE (mm) 20.0 ± 4.2 13.6 ± 4.3* 14.7 ± 3.9 <0.001 S" (cm/s) 12.6 ± 3.3 8.7 ± 2.4* 9.1 ± 2.4 <0.001 Fractional area change (%) 48.3 ± 5.9 37.8 ± 8.0* 40.0 ± 9.0 <0.001 Right ventricular free wall strain (%) −21.3 ± 6.3 −15.8 ± 6.7* −16.9 ± 5.2 0.036 Tricuspid regurgitation velocity peak (m/s) 2.41 ± 0.29 2.43 ± 0.25 2.34 ± 0.32 0.37

Right ventricular TNF resistance during endotoxemia: the differential effects on ventricular function

2007 ◽  
Vol 293 (5) ◽  
pp. R1893-R1897 ◽  
Author(s):  
Troy A. Markel ◽  
Paul R. Crisostomo ◽  
Meijing Wang ◽  
Jeremy L. Herrmann ◽  
Aaron M. Abarbanell ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Ventricular Myocytes ◽  
Left Ventricular ◽  
Sprague Dawley ◽  
Endotoxin Exposure ◽  
Sprague Dawley Rats ◽  
Developed Pressure ◽  
The Right ◽  
Rv Function

Right and left ventricular myocytes originate from different cellular progenitors; however, it is unknown whether these cells differ in their response to endotoxemia. We hypothesized that 1) the percentage of endotoxemic functional depression within the right ventricle (RV) would be smaller than that of the left ventricle; and 2) that better RV function would correlate with lower levels of right ventricular TNF production. Adult Sprague-Dawley rats were divided into right and left control and endotoxin groups. Controls received vehicle, while endotoxin groups received LPS at 20 mg/kg ip. Hearts were excised either 2 or 6 h after injection. Hearts excised at 2 h were assayed for TNF, IL-6, TNF receptor 1 (TNFR1), TNFR2, and via ELISA, while hearts excised at 6 h were assayed via the Langendorff model. The percentage of cardiac functional depression, exhibited as developed pressure, contractility, and rate of relaxation (expressed as a percentage of control) was significantly smaller in right ventricles compared with left ventricles following endotoxin exposure. Tissue levels of TNF were significantly elevated in both right and left ventricles 2 h after endotoxin exposure, and right ventricular endotoxin groups expressed higher levels of TNF compared with their left ventricular counterparts. No significant differences in IL-6, TNFR1, or TNFR2 levels were noted between endotoxin-exposed ventricles. This is the first study to demonstrate that right and left ventricular function differs after endotoxin exposure.

Effects of regional ischemia and ventricular pacing on LV dP/dtmax-end-diastolic volume relation

1987 ◽  
Vol 252 (5) ◽  
pp. H933-H940 ◽  
Author(s):  
W. C. Little ◽  
R. C. Park ◽  
G. L. Freeman
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Ventricular Pressure ◽  
Free Wall ◽  
Ventricular Pacing ◽  
End Diastolic Volume ◽  
The Right

We investigated the effects of coronary artery occlusion and pacing from ventricular sites on the relation of the maximum rate of rise of left ventricular pressure (dP/dtmax) to the end-diastolic volume (VED) in dogs previously instrumented to measure left ventricular pressure and to determine left ventricular volume from three ultrasonically measured dimensions. The dP/dtmax-VED relation was generated by vena caval occlusion and compared with the simultaneously produced end-systolic pressure-end-systolic volume (PES-VES) relation. The dP/dtmax-VED relation was described by a straight line during all conditions. Occlusion of the left circumflex coronary artery produced a rightward shift of the dP/dtmax-VED relation, increasing the volume intercept by 11.3 +/- 5.3 (SD) ml (P less than 0.05). Compared with atrial pacing, the dP/dtmax-VED relation was shifted to the right with the volume intercept increasing by 4.8 +/- 4.4 ml (P less than 0.05) during pacing from the right ventricular free wall, 3.7 +/- 5.0 ml (P less than 0.05) during pacing from the right ventricular apex, and 3.7 +/- 2.4 ml (P less than 0.05) during pacing from the left ventricular free wall. Similar increases were observed in the volume intercepts of the PES-VES relations during coronary occlusion or ventricular pacing. These results are consistent with the predictions of the time-varying elastance model and support its use as a conceptual framework to understand left ventricular performance during isovolumic contraction and at end systole, both in the normal ventricle and the ventricle with regional abnormalities of contraction.

Myocardial interaction between the ventricles

1976 ◽  
Vol 41 (3) ◽  
pp. 362-368 ◽  
Author(s):  
W. P. Santamore ◽  
P. R. Lynch ◽  
G. Meier ◽  
J. Heckman ◽  
A. A. Bove
Keyword(s):  
Right Ventricular ◽  
Diastolic Pressure ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
The Other ◽  
Volume Increase ◽  
Lv Volume ◽  
Developed Pressure ◽  
Pressure Changes

The myocardial interaction between the ventricles was studied using isolated, flow-perfused, paced rabbit hearts beating isovolumically. In general, increasing left ventricular (LV) volume increased right ventricular (RV) diastolic and developed pressures. In particular, with a peak RV volume (RVV), increasing LV volume (LVV) from zero to two-thirds of its peak volume increase RV diastolic pressure by 1.7 mmHg (N=10, P less than 0.001) and RV developed pressure by 1.5 mmHg (N=10,P less than 0.001). For the LV, small RVV caused LV diastolic and developed pressure to increase, while large RVV increased LV diastolic pressure but decreased LV developed pressure. With a LVV held at two-third of peak volume, increasing RVV from zero to its peak volume caused LV diastolic pressure to increase by 2.5 mmHg (N=10,P less than 0.001) and LV developed pressure to decrease by 2.0 mmHg (N=10, P less than 0.001). The position of the interventricular septum correlated with LV diastolic pressure and RV diastolic and developed pressure changes (P less than 0.01). The results demonstrate that the diastolic and developed pressure-volume relationships of either ventricle can be acutely altered by varying the volume of the other ventricle.

6066Equal significance of longitudinal and radial wall motion represents the normal right ventricular mechanical pattern: 3D echocardiographic study in 231 healthy volunteers

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kovacs ◽  
Y Nabeshima ◽  
B Lakatos ◽  
Y Nagata ◽  
M Tokodi ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Healthy Volunteers ◽  
Left Ventricular ◽  
Relative Importance ◽  
Free Wall ◽  
Radial Wall ◽  
Physiological Conditions ◽  
Relative Contribution ◽  
Rv Function

Abstract Three main mechanisms contribute to right ventricular (RV) pump function: (1) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (2) inward (radial) movement of the RV free wall, which is often referred as the “bellows effect”; and (3) bulging of the interventricular septum into the RV during the left ventricular contraction and stretching of the free wall over the septum (causing shortening in the anteroposterior direction). Despite the established clinical value of the functional changes among the aforementioned components, their relative importance remains to be quantified during physiological conditions. Accordingly, the aim of our study was to evaluate the relative contribution of the different RV motion directions to global RV function on both global and segmental level in a large set of healthy individuals. We have recruited 231 healthy volunteers (44% female, with a wide and balanced age range from 8 to 81 years) from two experienced centers performing transthoracic 3D echocardiography (3DE) on a routine basis. 3DE datasets focused on the RV were obtained using multi-beat acquisition. We determined RV volumes and subsequent ejection fraction (RVEF) by dedicated software. Using the ReVISION method, we have decomposed the motion of the RV to determine longitudinal (LEF), radial (REF) and anteroposterior ejection fraction (AEF). Their ratio to RVEF quantifies the relative contribution of the given component to global RV function. Moreover, regional subvolumes were also analyzed in a 15-segment model. Mean value of RVEF was significantly higher in female subjects compared to male subjects (60±7 vs. 56±7%, p<0.001). The relative contributions of LEF and REF to RVEF were comparable, while the contribution of AEF was significantly lower (LEF/RVEF vs. REF/RVEF vs. AEF/RVEF: 0.48±0.08 vs. 0.49±0.07 vs. 0.39±0.11, p<0.001) in the pooled population as well as in the genders separately. In line with higher RVEF found in women, female gender was associated with a higher longitudinal and radial contribution compared to males, however, AEF was similar (women vs. men; LEF/RVEF: 0.49±0.08 vs. 0.47±0.07, p<0.05; REF/RVEF: 0.50±0.07 vs. 0.48±0.06, p<0.01; AEF/RVEF: 0.38±0.12 vs. 0.40±0.10, p=NS). Interestingly, AEF/RVEF showed a significant deterioration with age (r=−0.354, p<0.001), while age-dependency of the longitudinal and radial contributions were not observed concerning both genders. An age-related decrease could be demonstrated by the volume fractions of the 5 septal volumetric segments (r=−0.229, p<0.001). Motion decomposition and the 15 segments In physiological conditions, the relative importance of longitudinal and radial wall motions is similar in determining global RV function. Aging accompanied by a decrease in anteroposterior shortening, which may point to a deteriorating systolic LV-RV interaction. Our results may facilitate further research concerning the alterations of RV mechanical pattern in various disease states.

scholarly journals Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study

2020 ◽  
Author(s):  
Fei Gao ◽  
Chong Liu ◽  
Qiang Guo ◽  
Shuang-quan Jiang ◽  
Zhen-zhen Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Three Dimensional ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Free Wall ◽  
Two Dimensional ◽  
Dimensional Echocardiography ◽  
Rv Function

Abstract Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain.Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV.Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p<0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05).Conclusion：Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in chronic left-sided heart failure patients with left ventricular EF <45%. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.

Repair of Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) beyond Infancy

2013 ◽  
Vol 16 (4) ◽  
pp. 210 ◽  
Author(s):  
Sachin Talwar ◽  
Aandrei Jivendra Jha ◽  
Shiv Kumar Choudhary ◽  
Saurabh Kumar Gupta ◽  
Balram Airan
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Respiratory Tract ◽  
Left Coronary Artery ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anomalous Left Coronary Artery ◽  
Tract Infections ◽  
Anomalous Left Coronary

Between January 2002 and December 2012, five patients (4 female) underwent corrective surgery for anomalous left coronary artery from pulmonary artery (ALCAPA). They were older than 1 year (range, 3-56 years). One of the 2 patients younger than 10 years had presented with congestive heart failure, and the other had experienced repeated episodes of lower respiratory tract infection since childhood. Of the remaining 3 adult patients, 2 had experienced angina with effort, and 1 patient had had repeated respiratory tract infections since childhood, with mild dyspnea on effort of New York Heart Association (NYHA) class II. Three patients had the anomalous left coronary artery implanted directly into the ascending aorta via coronary-button transfer, and 2 patients underwent coronary artery bypass with obliteration of the left main ostium. Two patients underwent concomitant mitral valve repair procedures, and 1 patient underwent direct closure of a perimembranous ventricular septal defect. Four patients survived the surgery, and 1 patient died because of a persistently low cardiac output. Follow-up times ranged from 3 months to 4 years. All survivors are in NYHA class I and have left ventricular ejection fractions of 45% to 60%, with moderate (n = 1), mild (n = 1), or no (n = 2) mitral insufficiency. We conclude that a few naturally selected patients with ALCAPA do survive beyond infancy and can undergo establishment of 2 coronary systems with satisfactory results.

CMR markers for early right ventricular dysfunction in precapillary pulmonary hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vos ◽  
T Leiner ◽  
A.P.J Van Dijk ◽  
F.J Meijboom ◽  
G.T Sieswerda ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Circumferential Strain ◽  
Peak Strain ◽  
Healthy Controls ◽  
Free Wall ◽  
Global Circumferential Strain ◽  
The Right ◽  
Rv Function

Abstract Introduction Precapillary pulmonary hypertension (pPH) causes right ventricular (RV) pressure overload inducing RV remodeling, often resulting in dysfunction and dilatation, heart failure, and ultimately death. The ability of the right ventricle to adequately adapt to increased pressure loading is key for patients' prognosis. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) is related to outcome in pPH patients, but this global measurement is not ideal for detecting early changes in RV function. Strain analysis on CMR using feature tracking (FT) software provides a more detailed assessment, and might therefore detect early changes in RV function. Aim 1) To compare RV strain parameters in pPH patients and healthy controls, and 2) to compare strain parameters in a subgroup of pPH patients with preserved RVEF (pRVEF) and healthy controls. Methods In this prospective study, a CMR was performed in pPH patients and healthy controls. Using FT-software on standard cine images, the following RV strain parameters were analyzed: global, septal, and free wall longitudinal strain (GLS, sept-LS, free wall-LS), time to peak strain (TTP, as a % of the whole cardiac cycle), the fractional area change (FAC), global circumferential strain (GCS), global longitudinal and global circumferential strain rate (GLSR and GCSR, respectively). A pRVEF is defined as a RVEF &gt;50%. To compare RV strain parameters in pPH patients to healthy controls, the Mann-Whitney U test was used. Results 33 pPH-patients (55 [45–63] yrs; 10 (30%) male) and 22 healthy controls (40 [36–48] yrs; 15 (68%) male) were included. All RV strain parameters were significantly reduced in pPH patients compared to healthy controls (see table), except for GCS and GCSR. Most importantly, in pPH patients with pRVEF (n=8) GLS (−26.6% [−22.6 to −27.3] vs. −28.1% [−26.2 to −30.6], p=0.04), sept-LS (−21.2% [−19.8 to −23.2] vs. −26.0% [−24.0 to −27.9], p=0.005), and FAC (39% [35–44] vs. 44% [42–47], p=0.02) were still significantly impaired compared to healthy controls. The RV TTP was significantly increased in pPH patients compared to healthy controls (47% [44–57] vs. 40% [33–43], p≤0.001). Conclusions Several CMR-FT strain parameters of the right ventricle are impaired in pPH patients when compared to healthy controls. Moreover, even in pPH patients with a preserved RVEF multiple RV strain parameters (GLS, sept-LS, and FAC) remained significantly impaired, and TTP significantly prolonged, in comparison to healthy controls. This suggests that RV strain parameters may be used as an early marker of RV dysfunction in pPH patients. Funding Acknowledgement Type of funding source: None

scholarly journals N-Terminal Pro-Brain Natriuretic Peptide and Right Ventricular Diameter Are Related to Aspirin Resistance in Coronary Artery Disease Patients

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 706
Author(s):  
Kamila Marika Cygulska ◽  
Łukasz Figiel ◽  
Dariusz Sławek ◽  
Małgorzata Wraga ◽  
Marek Dąbrowa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Brain Natriuretic Peptide ◽  
Right Ventricular ◽  
Left Ventricular Mass ◽  
Natriuretic Peptide ◽  
Hemoglobin Concentration ◽  
Left Ventricular ◽  
Ventricular Mass ◽  
Artery Disease

Background and Objectives: Resistance to ASA (ASAres) is a multifactorial phenomenon defined as insufficient reduction of platelet reactivity through incomplete inhibition of thromboxane A2 synthesis. The aim is to reassess the prevalence and predictors of ASAres in a contemporary cohort of coronary artery disease (CAD) patients (pts) on stable therapy with ASA, 75 mg o.d. Materials and Methods: We studied 205 patients with stable CAD treated with daily dose of 75 mg ASA for a minimum of one month. ASAres was defined as ARU (aspirin reaction units) ≥550 using the point-of-care VerifyNow Aspirin test. Results: ASAres was detected in 11.7% of patients. Modest but significant correlations were detected between ARU and concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) (r = 0.144; p = 0.04), body weight, body mass index, red blood cell distribution width, left ventricular mass, and septal end-systolic thickness, with trends for left ventricular mass index and prothrombin time. In multivariate regression analysis, log(NT-proBNP) was identified as the only independent predictor of ARU—partial r = 0.15, p = 0.03. Median concentrations of NT-proBNP were significantly higher in ASAres patients (median value 311.4 vs. 646.3 pg/mL; p = 0.046) and right ventricular diameter was larger, whereas mean corpuscular hemoglobin concentration was lower as compared to patients with adequate response to ASA. Conclusions: ASAres has significant prevalence in this contemporary CAD cohort and NT-proBNP has been identified as the independent correlate of on-treatment ARU, representing a predictor for ASAres, along with right ventricular enlargement and lower hemoglobin concentration in erythrocytes.

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