scholarly journals Right Ventricular End Diastolic Volume Influences Outcomes During Hospitalized COPD Exacerbations, and Subsequent Mortality

2021 ◽  
Author(s):  
P. Leong ◽  
M.I. Macdonald ◽  
P. King ◽  
C.R. Osadnik ◽  
B.S. Ko ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Copd Exacerbations ◽  
End Diastolic Volume

Norepinephrine and dobutamine improve cardiac index equally by supporting opposite sides of the heart in an experimental model of chronic pulmonary hypertension

2021 ◽  
Author(s):  
Janus Adler Hyldebrandt ◽  
Nikolaj Bøgh ◽  
Camilla Omann Christensen ◽  
Peter Agger
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
End Diastolic Volume ◽  
Chronic Pulmonary Hypertension ◽  
Blood Pressures ◽  
The Right

Abstract Background: Pulmonary hypertension is a significant risk factor in patients undergoing surgery. The combined effects of general anaesthesia and positive pressure ventilation can aggravate this condition and cause increased pulmonary blood pressures, reduced systemic blood pressures and ventricular contractility. Although perioperative use of inotropic support or vasopressors is almost mandatory for these patients, preference is disputed. In this study, we investigated the effects of norepinephrine and dobutamine and their ability to improve the arterio-ventricular relationship and haemodynamics in pigs suffering from chronic pulmonary hypertension.Method: Pulmonary hypertension was induced in five pigs by banding the pulmonary artery at 2–3 weeks of age. Six pigs served as controls. After 16 weeks of pulmonary artery banding, the animals were re-examined under general anaesthesia using biventricular conductance catheters and a pulmonary artery catheter. After baseline measurements, the animals were exposed to both norepinephrine and dobutamine infusions in incremental doses, with a stabilizing period in between the infusions. The hypothesis of differences between norepinephrine and dobutamine with incremental doses was tested using repeated two-way ANOVA and Bonferroni multiple comparisons post-test. Results: At baseline, pulmonary artery banded animals had increased right ventricular pressure (+39%, p=0.04), lower cardiac index (-23% p=0.04), lower systolic blood pressure (-13%, p=0.02) and reduced left ventricular end-diastolic volume (-33%, p=0.02). When incremental doses of norepinephrine and dobutamine were administered, the right ventricular arterio-ventricular coupling was improved only by dobutamine (p<0.05). Norepinephrine increased both left ventricular end-diastolic volume and left ventricular contractility to a greater extent (p<0.05) in pulmonary artery banded animals. While the cardiac index was improved equally by norepinephrine and dobutamine treatments in pulmonary artery banded animals, norepinephrine had a significantly greater effect on mean arterial pressure (p<0.05) and diastolic arterial pressure (p<0.05).Conclusion: While norepinephrine and dobutamine improved cardiac index equally, it was obtained in different manners. Dobutamine significantly improved the right ventricular function and the arterio-ventricular coupling. Norepinephrine increased systemic resistance, thereby improving arterial pressures and left ventricular systolic function by maintaining left ventricular end-diastolic volume.

Abstract 15314: Left Ventricular Dysfunction in Children and Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Paweena Chungsomprasong ◽  
Robert Hamilton ◽  
Wietske Luining ◽  
Shi-Joon Yoo ◽  
Meena Fatah ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Task Force ◽  
Myocardial Dysfunction ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Myocardial Strain ◽  
Young Patients ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Cardiomyopathy ◽  
End Diastolic Volume

Background: Involvement of the left ventricle (LV) is increasingly recognized in adults with arrhythmogenic right ventricular cardiomyopathy (ARVC) but it is unclear whether LV function is compromised in children with this condition. The aim of this study was examine myocardial contractility in pediatric patients with suspected ARVC. Methods: For this retrospective study, patients with a work-up for ARVC were classified into ‘no’, ‘possible’, ‘borderline’ or ‘definite’ ARVC according to the revised Task Force Criteria (rTFC). Ventricular size and function as well as LV myocardial strain and torsion were measured by cardiac magnetic resonance (CMR). Results: A total of 142 patients were enrolled, of whom 58 (41%) had no, 32 (23%) possible, 29 (20%) borderline and 23 (16%) definite ARVC. The groups were similar in age at CMR. With higher rTFC score, z scores (Z) of right ventricular (RV) ejection fraction (EF) were lower (p<0.001) while z-RV end diastolic volume (EDV) and z-LV EDV were larger (p=0.002 and 0.013, respectively). LV EF did not differ between rTFC categories. Global circumferential strain (GCS) of the LV was lower in patients in higher rTFC categories (p=0.018). Z-LVEDV correlated with z-RVEDV (r2 = 0.69, p<0.001) and z- LVEF correlated with z-RVEF (r2 = 0.55, p <0.001). Z-LVEF and z-RVEF correlated with LV GCS (r2 = 0.48, p<0.001 and r2 = 0.46, p<0.001, respectively) and torsion (r2 = 0.21, p=0.032 for both). Forty-two patients had a follow-up CMR, after a median interval of 2.6 years (0.4- 8.4). The rate of deterioration of LV or RV EF or EDV did not differ between rTFC categories. A more rapid increase of z-RVEDV was associated with a faster decline in z-RVEF (r2 = -0.383, p=0.004) and z-LVEF (r2 = -0.45, p=0.001). A decline of z-LVEF over time correlated with that of z-RVEF (r2 = 0.60, p<0.001) and z-LVEDV increase correlated with z-RVEDV increase (r2 = 0.84, p<0.001). Conclusion: LV myocardial dysfunction is present in young patients with suspected or confirmed ARVC. Quantification of myocardial mechanics with CMR may be a useful tool to detect early LV involvement in ARVC. Progressive LV dysfunction and enlargement appear to parallel those of the RV.

P595Characteristics of the right ventricle in patients with nonischemic dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Becker ◽  
C P Allaart ◽  
M Wubben ◽  
J H Cornel ◽  
A C Van Rossum ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Ventricular Function ◽  
Left Atrial ◽  
Systolic Dysfunction ◽  
Underlying Mechanism ◽  
Left Ventricular ◽  
End Diastolic Volume ◽  
Nonischemic Dilated Cardiomyopathy

Abstract Background In nonischemic dilated cardiomyopathy (DCM), diagnosis and prognosis is based on left ventricular function. Although concomitant right ventricular (RV) dysfunction is frequently observed, the underlying mechanism is currently not fully understood. Purpose We aimed to describe the characteristics of right ventricular function in DCM patients with cardiac magnetic resonance (CMR) imaging using cine and late-gadolinium enhancement (LGE) imaging. Methods Patients with DCM and left ventricular (LV) dysfunction (ejection fraction (EF) <50%) on LGE-CMR were included prospectively. LV and RV volumes and function were quantified and RV systolic dysfunction was defined as RV ejection fraction (RVEF)<45%. The presence and pattern of LGE were assessed visually and the extent was quantified using the full-width half maximum method. Septal midmyocardial LGE pattern was defined as midwall striae or hinge-point myocardial hyperenhancement. Moreover, left atrial (LA) volumes were calculated using the bi-plane area-length method. Results The study included 214 DCM patients (42% female, age 58±14 years) with a mean LVEF of 34±12% and RVEF of 46±12%. RV systolic dysfunction was present in 39% and was associated with the presence of septal midwall LGE (OR 1.96 (95% CI 1.09–3.54) p=0.026). In patients with RV dysfunction, LV dilation was more severe (LV end diastolic volume (EDV) 242±97mL vs. 212±58mL, p=0.011) and LVEF was lowere (26±12% vs. 39±8%, p<0.001) (figure A). There was a weak correlation between septal LGE amount and LVEDV and RVEDV (respectively r=0.36, p=0.003 and r=0.35, p=0.005) In patients with RV dysfunction, left atrial volumes were enlarged (56±23mL/m2 vs. 46±14mL/m2, p<0.001) and LA emptying fraction was moderately correlated to RVEF (figure B), also after exclusion of patients with a history of atrial fibrillation. RVEF in DCM patients Conclusion In DCM, reduced RVEF predominantly occurred in patients with a) LVEF lower than 30%, b) septal midwall enhancement, indicating progressive LV remodeling, c) LA dilation and d) LA dysfunction. This suggests that RV dysfunction in advanced DCM is drive by LV diastolic dysfunction resulting in increased afterload of the RV.

Effect of continuous pressure breathing on right ventricular volumes

1967 ◽  
Vol 22 (6) ◽  
pp. 1053-1060 ◽  
Author(s):  
Maylene Wong ◽  
Edgardo E. Escobar ◽  
Gilberto Martinez ◽  
John Butler ◽  
Elliot Rapaport
Keyword(s):  
Right Ventricular ◽  
Negative Pressure ◽  
Atmospheric Pressure ◽  
Diastolic Pressure ◽  
Venous Pressure ◽  
Intrathoracic Pressure ◽  
Transmural Pressure ◽  
Positive Pressure ◽  
End Diastolic Volume ◽  
Negative Pressure Breathing

We measured the end-diastolic volume (EDV) and stroke volume (SV) in the right ventricle of anesthetized dogs during continuous pressure breathing and compared them to measurements taken during breathing at atmospheric pressure. During intratracheal positive-pressure breathing, EDV, and SV decreased and end-diastolic pressure became more positive relative to atmospheric pressure. During intratracheal negative-pressure breathing, EDV enlarged and SV tended to increase; end-diastolic pressure became more negative. During extrathoracic negative-pressure breathing SV decreased, EDV fell, though not significantly, and end-diastolic pressure rose, but insignificantly. Changes in EDV observed during intratracheal positive-pressure breathing and intratracheal negative-pressure breathing were associated with minor shifts in transmural pressure (end-diastolic pressure minus intrapleural pressure) in the expected directions, but during extrathoracic negative-pressure breathing a large increase in transmural pressure took place with the nonsignificant reduction in EDV. We believe that intrathoracic pressure influences right ventricular filling by changing the peripheral-to-central venous pressure gradient. The cause of the alteration in diastolic ventricular distensibility demonstrated during extra-thoracic negative-pressure breathing remains unexplained. positive-pressure breathing; negative-pressure breathing; extrathoracic negative-pressure breathing Submitted on August 16, 1966

Rapid in vivo determinations of instantaneous right ventricular pressure and volume in dogs

1988 ◽  
Vol 254 (4) ◽  
pp. H622-H630 ◽  
Author(s):  
F. Schwiep ◽  
S. S. Cassidy ◽  
M. Ramanathan ◽  
R. L. Johnson
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Volume ◽  
Pentobarbital Anesthesia ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Radiopaque Markers ◽  
Four Levels ◽  
Isovolumic Relaxation

We have developed a method for measuring in vivo canine right ventricular (RV) volume at a frequency of 60 Hz. In six dogs (17-22 kg), under pentobarbital anesthesia, 18 radiopaque markers were surgically implanted in the RV myocardium to maximally represent the RV shell. The xyz-coordinates of the markers were obtained from biplane cineradiographic recordings. RV volume was calculated from the polyhedron created by the markers by decomposing the polyhedron into 24 tetrahedrons, each of whose volumes could be solved from the xyz-coordinates of markers. RV volume was obtained each 16.7 ms, permitting detailed representation if RV volume dynamics. RV end-diastolic volume, end-systolic volume, and ejection fraction averaged 41.3 +/- 10.9, 23.0 +/- 5.8, and 0.44 +/- 0.05 ml, respectively. By simultaneously measuring RV pressure, RV pressure-volume loops were constructed that demonstrated that RV ejection occurred without significant isovolumic contraction, although isovolumic relaxation occurred at end systole. RV systolic elastance was determined in two dogs by imposing four levels of RV afterload. Maximal systolic elastance averaged 4.14 mmHg/ml under control conditions and 9.20 mmHg/ml during dobutamine infusion.

Biventricular morphology in adults born with a ventricular septal defect

2018 ◽  
Vol 28 (12) ◽  
pp. 1379-1385 ◽  
Author(s):  
Marie Maagaard ◽  
Johan Heiberg ◽  
Filip Eckerström ◽  
Benjamin Asschenfeldt ◽  
Christian E. Rex ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricular ◽  
Septal Defect ◽  
Volume Index ◽  
Peak Exercise ◽  
Stroke Index ◽  
Healthy Controls ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
End Diastolic Volume

AbstractVentricular septal defects – large, surgically closed or small, untreated – have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups’ right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.

Preload-adjusted maximal power of right ventricle: contribution of end-systolic P-V relation intercept

2002 ◽  
Vol 283 (4) ◽  
pp. H1681-H1687 ◽  
Author(s):  
Patrick Segers ◽  
H. Alex Leather ◽  
Pascal Verdonck ◽  
Yuan-Yuan Sun ◽  
Patrick F. Wouters
Keyword(s):  
Steady State ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Pulmonary Artery Pressure ◽  
Strong Relationship ◽  
Maximal Power ◽  
State Data ◽  
End Diastolic Volume ◽  
Inotropic Stimulation

To assess whether preload-adjusted maximal power (PAMP), which is calculated asW˙max/V[Formula: see text] (whereW˙max is maximal power and Ved is end-diastolic volume with β = 2) is an index of right ventricular (RV) contractility, we measured RV pressure (P) and volume (V) and pulmonary artery pressure and flow in 10 dogs at baseline and after inotropic stimulation. PAMP was derived from steady-state data, whereas the slope ( E es) and intercept (Vd) of the end-systolic P-V relationship were derived from data obtained during vena caval occlusion. Inotropic stimulation increased E es (from 0.96 ± 0.25 to 1.62 ± 0.28 mmHg/ml; P < 0.001) and Vd (from −3.0 ± 17.2 to 12.4 ± 10.8 ml; P < 0.05) but not PAMP (from 0.24 ± 0.10 to 0.36 ± 0.22 mW/ml2; P = 0.09). We found a strong relationship between the optimal β-factor for preload adjustment and Vd. A corrected PAMP, PAMPc= W˙max/(Ved − Vd)2, which incorporated the Vddependency, was sensitive to the inotropic changes (from 0.23 ± 0.12 to 0.54 ± 0.17 mW/ml2; P < 0.001) with a good correlation with E es( r = 0.88; P < 0.001).

scholarly journals Effect of the mechanical ventilatory cycle on thermodilution right ventricular volumes and cardiac output

2000 ◽  
Vol 89 (1) ◽  
pp. 89-96 ◽  
Author(s):  
A. B. Johan Groeneveld ◽  
Remco R. Berendsen ◽  
Anton J. Schneider ◽  
Ioannis A. Pneumatikos ◽  
Leo A. Stokkel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Mean Value ◽  
Mean Values ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Reliable Assessment ◽  
End Systolic Volume

The purpose of this study was to evaluate right ventricular (RV) loading and cardiac output changes, by using the thermodilution technique, during the mechanical ventilatory cycle. Fifteen critically ill patients on mechanical ventilation, with 5 cmH2O of positive end-expiratory pressure, mean respiratory frequency of 18 breaths/min, and mean tidal volume of 708 ml, were studied with help of a rapid-response thermistor RV ejection fraction pulmonary artery catheter, allowing 5-ml room-temperature 5% isotonic dextrose thermodilution measurements of cardiac index (CI), stroke volume (SV) index, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) indexes at 10% intervals of the mechanical ventilatory cycle. The ventilatory modulation of CI and RV volumes varied from patient to patient, and the interindividual variability was greater for the latter variables. Within patients also, RV volumes were modulated more by the ventilatory cycle than CI and SV index. Around a mean value of 3.95 ± 1.18 l · min−1 · m−2 (= 100%), CI varied from 87.3 ± 5.2 (minimum) to 114.3 ± 5.1% (maximum), and RVESV index varied between 61.5 ± 17.8 and 149.3 ± 34.1% of mean 55.1 ± 17.9 ml/m2 during the ventilatory cycle. The variations in the cycle exceeded the measurement error even though the latter was greater for RVEF and volumes than for CI and SV index. For mean values, there was an inspiratory decrease in RVEF and increase in RVESV, whereas a rise in RVEDV largely prevented a fall in SV index. We conclude that cyclic RV afterloading necessitates multiple thermodilution measurements equally spaced in the ventilatory cycle for reliable assessment of RV performance during mechanical ventilation of patients.

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