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Chapel EH, Scansen BA, Schober KE, Bonagura JD. Echocardiographic Estimates of Right Ventricular Systolic Function in Dogs with Myxomatous Mitral Valve Disease. J Vet Intern Med 2017; 32:64-71. [PMID: 29224256 PMCID: PMC5787149 DOI: 10.1111/jvim.14884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/01/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023] Open
Abstract
Background Right ventricular (RV) dysfunction independently predicts outcomes in human myxomatous mitral valve disease (MMVD). There is limited information regarding RV systolic function in dogs with MMVD. Hypothesis Right ventricular systolic function differs among stages of disease, decreasing in decompensated MMVD. Animals Thirty‐sixclient‐owned dogs with MMVD not receiving oral cardiovascular medications. Methods Prospective clinical study. Dogs were categorized according to disease severity as ACVIM Stage B1, B2, or C. Seven echocardiographic indices of RV systolic function were measured. Groups were compared by 1‐way ANOVA and Tukey's HSD test. Frequencies of cases with cardiac remodeling falling outside previously established reference intervals were compared using Fisher's exact test. Intra‐ and interobserver measurement variability was calculated for each RV function index. Results The indices TAPSE (P = 0.029), RV StL (P = 0.012), and RV StRL (P = 0.041) were significantly different between groups. A greater proportion of B2 dogs (7 of 12) had TAPSE values above reference intervals compared with B1 (2 of 12) or C (2 of 12) dogs (P = 0.027). Measurement variability of TAPSE, RV S', and RV StG was clinically acceptable. Conclusions and Clinical Importance Right ventricular systolic function differs between stages of MMVD, increasing in stage B2, and declining in stage C. The prognostic importance of RV function indices, particularly TAPSE, might be worth evaluating in dogs with MMVD.
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Affiliation(s)
- E H Chapel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - B A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - K E Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - J D Bonagura
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
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Liu A, Philip J, Vinnakota KC, Van den Bergh F, Tabima DM, Hacker T, Beard DA, Chesler NC. Estrogen maintains mitochondrial content and function in the right ventricle of rats with pulmonary hypertension. Physiol Rep 2017; 5:5/6/e13157. [PMID: 28320896 PMCID: PMC5371553 DOI: 10.14814/phy2.13157] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 12/15/2022] Open
Abstract
The typical cause of death in pulmonary hypertension (PH) is right ventricular (RV) failure, with females showing better survival rates than males. Recently, metabolic shift and mitochondrial dysfunction have been demonstrated in RV failure secondary to PH In light of evidence showing that estrogen protects mitochondrial function and biogenesis in noncardiovascular systems, we hypothesized that the mechanism by which estrogen preserves RV function is via protection of mitochondrial content and oxidative capacity in PH We used a well-established model of PH (Sugen+Hypoxia) in ovariectomized female rats with/without estrogen treatment. RV functional measures were derived from pressure-volume relationships measured via RV catheterization in live rats. Citrate synthase activity, a marker of mitochondrial density, was measured in both RV and LV tissues. Respiratory capacity of mitochondria isolated from RV was measured using oxygraphy. We found that RV ventricular-vascular coupling efficiency decreased in the placebo-treated SuHx rats (0.78 ± 0.10 vs. 1.50 ± 0.13 in control, P < 0.05), whereas estrogen restored it. Mitochondrial density decreased in placebo-treated SuHx rats (0.12 ± 0.01 vs. 0.15 ± 0.01 U citrate synthase/mg in control, P < 0.05), and estrogen attenuated the decrease. Mitochondrial quality and oxidative capacity tended to be lower in placebo-treated SuHx rats only. The changes in mitochondrial biogenesis and function paralleled the expression levels of PGC-1α in RV Our results suggest that estrogen protects RV function by preserving mitochondrial content and oxidative capacity. This provides a mechanism by which estrogen provides protection in female PH patients and paves the way to develop estrogen and its targets as a novel RV-specific therapy for PH.
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Affiliation(s)
- Aiping Liu
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jennifer Philip
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kalyan C Vinnakota
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Francoise Van den Bergh
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Diana M Tabima
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy Hacker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel A Beard
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin .,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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153
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Anabtawi A, Mondragon J, Dodendorf D, Laskey WK. Late-stage left ventricular dysfunction in adult survivors of tetralogy of Fallot repair in childhood. Open Heart 2017; 4:e000690. [PMID: 29225904 PMCID: PMC5708319 DOI: 10.1136/openhrt-2017-000690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/24/2017] [Accepted: 11/07/2017] [Indexed: 11/20/2022] Open
Abstract
Objective Left ventricular systolic dysfunction (LVSD) in adult survivors of tetralogy of Fallot (TOF) repair in childhood has been observed, although the relationship with long-term outcome remains inadequately described. Methods A cohort of 44 consecutive adult patients with TOF repair in childhood were followed prospectively from January 2001 through June 2016. LVSD was defined as an echocardiographically derived left ventricular (LV) ejection fraction <0.55. Clinical and demographic characteristics in patients with and without LVSD were compared. Event-free survival (all-cause death or hospitalisation) was estimated using the product limit method. Results The average time from childhood surgical repair to cohort inception was similar between groups (LVSD, 33.7±12.7 years; normal LV function, 36.1±14.9 years; P=0.62) as were their mean ages (LVSD, 36.5±14.5 years; normal LV function, 40.7±15.2 years; P=0.73). Patients with LVSD (n=13) had more prior surgeries, more frequent history of significant pulmonic regurgitation, right ventricular systolic dysfunction and more implantable cardiac devices. Over a total observation time of 15.5 years, patients with LVSD were at significantly higher risk of all-cause death or hospitalisation (P=0.006). Onset of LVSD frequently preceded an adverse outcome. Conclusions In this cohort of adult patients with TOF repair in childhood followed for a total of 550 patient-years, the frequency of LVSD was 30%. LVSD was associated with lower event-free survival. The appearance of LVSD many years after TOF repair may herald the onset of an adverse outcome.
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Affiliation(s)
- Abdel Anabtawi
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Judith Mondragon
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Diane Dodendorf
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Warren K Laskey
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Malinowski M, Proudfoot AG, Langholz D, Eberhart L, Brown M, Schubert H, Wodarek J, Timek TA. Large animal model of functional tricuspid regurgitation in pacing induced end-stage heart failure. Interact Cardiovasc Thorac Surg 2017; 24:905-910. [PMID: 28329164 DOI: 10.1093/icvts/ivx012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Functional tricuspid regurgitation (FTR) is common in patients with advanced heart failure and frequently complicates left ventricular assist device implantation yet remains poorly understood. We set out to establish large animal model of FTR that could serve as a research platform to investigate the pathogenesis of FTR associated with end-stage heart failure. METHODS : Through right thoracotomy, ten adult sheep underwent implantation of pacemaker with epicardial LV lead, five sonomicrometry crystals on the right ventricle, and left and right ventricular telemetry pressure sensors during a beating heart off-pump procedure. After 5 ± 1 days of recovery, baseline haemodynamic, echocardiographic and sonomicrometry data were collected. Animals were paced thereafter at a rate of 220-240 beats/min until the development of heart failure and concomitant tricuspid regurgitation. RESULTS : Three animals died during early recovery period and one during the pacing phase. Six surviving animals were paced for a mean of 14 ± 5 days. Cardiac function was significantly depressed compared to baseline, with LV ejection fraction falling from 69 ± 2% to 22 ± 4% ( P < 0.001) and RV fractional area change from 52 ± 11% to 25 ± 9% ( P = 0.005). All animals developed significant enlargement of tricuspid annulus (from 29.5 ± 1.6 to 36.5 ± 4.5 mm; P = 0.01) and right ventricle (from 21.9 ± 0.2 to 30.3 ± 0.6 mm; P = 0.03). Sonomicrometry derived contractility of RV free wall was depressed and at least moderate tricuspid insufficiency developed in all animals. CONCLUSIONS : Biventricular dysfunction, tricuspid annular dilatation and significant FTR were observed in our model of ovine tachycardia induced cardiomyopathy. This animal model reflects the clinical situation of end-stage heart failure patients presenting for mechanical support.
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Affiliation(s)
- Marcin Malinowski
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA.,Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | | | - David Langholz
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
| | - Lenora Eberhart
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
| | - Michael Brown
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
| | - Hans Schubert
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
| | - Jeremy Wodarek
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
| | - Tomasz A Timek
- Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, MI, USA
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155
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Pueschner A, Chattranukulchai P, Heitner JF, Shah DJ, Hayes B, Rehwald W, Parker MA, Kim HW, Judd RM, Kim RJ, Klem I. The Prevalence, Correlates, and Impact on Cardiac Mortality of Right Ventricular Dysfunction in Nonischemic Cardiomyopathy. JACC Cardiovasc Imaging 2017; 10:1225-1236. [DOI: 10.1016/j.jcmg.2017.06.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 11/28/2022]
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156
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Oketona OA, Balogun MO, Akintomide AO, Ajayi OE, Adebayo RA, Mene-Afejuku TO, Oketona OT, Bamikole OJ. Right ventricular systolic function in hypertensive heart failure. Vasc Health Risk Manag 2017; 13:353-360. [PMID: 29033578 PMCID: PMC5628700 DOI: 10.2147/vhrm.s142429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters. METHODOLOGY One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S'). RESULTS RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S'. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF. CONCLUSION A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S'. Prevalence of RV systolic dysfunction increased with reducing LVEF.
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Affiliation(s)
- O A Oketona
- Fort Nelson General Hospital, Fort Nelson, BC, Canada
| | - M O Balogun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - A O Akintomide
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - O E Ajayi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - R A Adebayo
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
| | - T O Mene-Afejuku
- Department of Medicine, Metropolitan Hospital Center, New York, NY, USA
| | - O T Oketona
- Fort Nelson General Hospital, Fort Nelson, BC, Canada
| | - O J Bamikole
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria
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157
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Naeije R, Gerges M, Vachiery JL, Caravita S, Gerges C, Lang IM. Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004082. [PMID: 28912263 DOI: 10.1161/circheartfailure.117.004082] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU). This combination of criteria defines isolated postcapillary PH. Postcapillary PH with elevated vascular gradients and pulmonary vascular resistance defines combined post- and precapillary PH (Cpc-PH). Postcapillary PH is associated with a decreased survival in proportion to increased pulmonary vascular gradients, decreased pulmonary arterial compliance, and reduced right ventricular function. The Cpc-PH subcategory occurs in 12% to 13% of patients with PH due to left heart disease. Patients with Cpc-PH have severe PH, with higher diastolic pulmonary pressure gradient, transpulmonary pressure gradient, and pulmonary vascular resistance and more pronounced ventilatory responses to exercise, lower pulmonary arterial compliance, depressed right ventricular ejection fraction, and shorter life expectancy than isolated postcapillary PH. Cpc-PH bears similarities to pulmonary arterial hypertension. Whether Cpc-PH is amenable to therapies targeting the pulmonary circulation remains to be tested by properly designed randomized controlled trials.
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Affiliation(s)
- Robert Naeije
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.)
| | - Mario Gerges
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.)
| | - Jean-Luc Vachiery
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.)
| | - Sergio Caravita
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.)
| | - Christian Gerges
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.)
| | - Irene M Lang
- From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.); and Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy (S.C.).
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159
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Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res 2017; 113:1474-1485. [DOI: 10.1093/cvr/cvx160] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 02/04/2023] Open
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160
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Guazzi M, Naeije R. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives. J Am Coll Cardiol 2017; 69:1718-1734. [PMID: 28359519 DOI: 10.1016/j.jacc.2017.01.051] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 02/08/2023]
Abstract
Pulmonary hypertension is a common hemodynamic complication of heart failure. Interest in left-sided pulmonary hypertension has increased remarkably in recent years because its development and consequences for the right heart are now seen as mainstay abnormalities that begin in the early stages of the disease and bear unfavorable prognostic insights. However, some knowledge gaps limit our ability to influence this complex condition. Accordingly, attention is now focused on: 1) establishing a definitive consensus for a hemodynamic definition, perhaps incorporating exercise and fluid challenge; 2) implementing the limited data available on the pathobiology of lung capillaries and small arteries; 3) developing standard methods for assessing right ventricular function and, hopefully, its coupling to pulmonary circulation; and 4) searching for effective therapies that may benefit lung vessels and the remodeled right ventricle. The authors review the pathophysiology, pathobiology, and emerging clinical perspectives on pulmonary hypertension across the broad spectrum of heart failure stages.
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Affiliation(s)
- Marco Guazzi
- IRCCS Policlinico San Donato Hospital, University of Milan, Milan, Italy.
| | - Robert Naeije
- Erasme Hospital, Free University of Brussels, Brussels, Belgium
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161
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Kuo AH, Li C, Huber HF, Schwab M, Nathanielsz PW, Clarke GD. Maternal nutrient restriction during pregnancy and lactation leads to impaired right ventricular function in young adult baboons. J Physiol 2017; 595:4245-4260. [PMID: 28439937 PMCID: PMC5491873 DOI: 10.1113/jp273928] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/03/2017] [Indexed: 01/25/2023] Open
Abstract
KEY POINTS Maternal nutrient restriction induces intrauterine growth restriction (IUGR) and leads to heightened cardiovascular risks later in life. We report right ventricular (RV) filling and ejection abnormalities in IUGR young adult baboons using cardiac magnetic resonance imaging. Both functional and morphological indicators of poor RV function were seen, many of which were similar to effects of ageing, but also with a few key differences. We observed more pronounced RV changes compared to our previous report of the left ventricle, suggesting there is likely to be a component of isolated RV abnormality in addition to expected haemodynamic sequelae from left ventricular dysfunction. In particular, our findings raise the suspicion of pulmonary hypertension after IUGR. This study establishes that IUGR also leads to impairment of the right ventricle in addition to the left ventricle classically studied. ABSTRACT Maternal nutrient restriction induces intrauterine growth restriction (IUGR), increasing later life chronic disease including cardiovascular dysfunction. Our left ventricular (LV) CMRI studies in IUGR baboons (8 M, 8 F, 5.7 years - human equivalent approximately 25 years), control offspring (8 M, 8 F, 5.6 years), and normal elderly (OLD) baboons (6 M, 6 F, mean 15.9 years) revealed long-term LV abnormalities in IUGR offspring. Although it is known that right ventricular (RV) function is dependent on LV health, the IUGR right ventricle remains poorly studied. We examined the right ventricle with cardiac magnetic resonance imaging in the same cohorts. We observed decreased ejection fraction (49 ± 2 vs. 33 ± 3%, P < 0.001), cardiac index (2.73 ± 0.27 vs. 1.89 ± 0.20 l min-1 m-2 , P < 0.05), early filling rate/body surface area (BSA) (109.2 ± 7.8 vs. 44.6 ± 7.3 ml s-1 m-2 , P < 0.001), wall thickening (61 ± 3 vs. 44 ± 5%, P < 0.05), and longitudinal shortening (26 ± 3 vs. 15 ± 2%, P < 0.01) in IUGR animals with increased chamber volumes. Many, but not all, of these changes share similarities to normal older animals. Our findings suggest IUGR-induced pulmonary hypertension should be further investigated and that atrial volume, pulmonic outflow and interventricular septal motion may provide valuable insights into IUGR cardiovascular physiology. Overall, our findings reaffirm that gestational and neonatal challenges can result in long-term programming of poor offspring cardiovascular health. To our knowledge, this is the first study reporting IUGR-induced programmed adult RV dysfunction in an experimental primate model.
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Affiliation(s)
- Anderson H. Kuo
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Cun Li
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | | | - Matthias Schwab
- Hans Berger Department for NeurologyUniversity HospitalJenaGermany
| | - Peter W. Nathanielsz
- Department of Animal ScienceUniversity of WyomingLaramieWYUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
| | - Geoffrey D. Clarke
- Department of Radiology and Research Imaging InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
- Southwest National Primate Research CenterSan AntonioTXUSA
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Bakir AA, Al Abed A, Lovell NH, Dokos S. A generic cardiac biventricular fluid-electromechanics model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3680-3683. [PMID: 29060697 DOI: 10.1109/embc.2017.8037656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a fully-coupled fluid-electromechanics model of the heart using a generic biventricular structure to provide a tool for future multiphysics interaction studies. A simplified Purkinje fibre structure was embedded within the myocardium along with transmural variation of action potential duration to obtain realistic activation and relaxation sequences. To ease computational requirements, phenomenological action potential and excitation-contraction formulations were chosen, and coupled to transverse isotropic hyperelastic myocardial material physics. The action potential propagation was discretised within the material frame to achieve electromechanical coupling with gap junction-controlled propagation. Blood haemodynamics was represented by incompressible Navier-Stokes equations, whereby, the endocardial displacement deforms the blood domain, whilst blood pressure and viscous stress exert load on the myocardium. Realistic electrical activation and relaxation sequences were achieved along with basic cardiac mechanical properties such as torsion and apex displacement. The pressure-volume loops for both ventricles matched known values, and vortex formation was noted during the filling phase. The model could facilitate a better understanding of multiphysics and biventricular interactions under pathologic conditions and help formulate better treatments.
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Tadic M, Pieske-Kraigher E, Cuspidi C, Morris DA, Burkhardt F, Baudisch A, Haßfeld S, Tschöpe C, Pieske B. Right ventricular strain in heart failure: Clinical perspective. Arch Cardiovasc Dis 2017; 110:562-571. [PMID: 28669483 DOI: 10.1016/j.acvd.2017.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 01/30/2023]
Abstract
The number of studies demonstrating the importance of right ventricular remodelling in a wide range of cardiovascular diseases has increased in the past two decades. Speckle-tracking imaging provides new variables that give comprehensive information about right ventricular function and mechanics. In this review, we summarize current knowledge of right ventricular mechanics in heart failure with reduced ejection fraction and preserved ejection fraction. We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 2000 to December 2016 in the English language using the following keywords: "right ventricle"; "strain"; "speckle tracking"; "heart failure with reduced ejection fraction"; and "heart failure with preserved ejection fraction". Investigations showed that right ventricular dysfunction is associated with higher cardiovascular and overall mortality in patients with heart failure, irrespective of ejection fraction. The number of studies investigating right ventricular strain in patients with heart failure with reduced ejection fraction is constantly increasing, whereas data on right ventricular mechanics in patients with heart failure with preserved ejection fraction are limited. Given the high feasibility, accuracy and clinical implications of right ventricular strain in the population with heart failure, it is of great importance to try to include the evaluation of right ventricular strain as a regular part of each echocardiographic examination in patients with heart failure. However, further investigations are necessary to establish right ventricular strain as a standard variable for decision-making.
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Affiliation(s)
- Marijana Tadic
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany.
| | | | - Cesare Cuspidi
- Clinical research unit, university of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Daniel A Morris
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany
| | - Franziska Burkhardt
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany
| | - Ana Baudisch
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany
| | - Sabine Haßfeld
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany
| | - Burket Pieske
- Department of cardiology, Charité-university-medicine Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin/Charité, Berlin, Germany; Department of cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
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164
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Silber D, Lachmann J. Invasive Hemodynamics of Pulmonary Disease and the Right Ventricle. Interv Cardiol Clin 2017; 6:329-343. [PMID: 28600088 DOI: 10.1016/j.iccl.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension (PH) falls into 5 groups, as defined by the World Health Organization. Swan-Ganz catheters determine precapillary versus postcapillary PH. The hemodynamic values of PH at rest and with vasodilatory challenge categorize the etiology of PH and guide treatment. RV maladaptations to increased pulmonary vascular resistance (PVR) and the chronicity of the right ventricle's (RV) response to increased PH and/or increased PVR can be understood with pressure-volume (PV) loops constructed with use of conductance catheters. These PV loops demonstrate the RV's ability to increase stroke volume in acutely and chronically increased PVR.
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Affiliation(s)
- David Silber
- Winthrop Cardiology Associates, PC, NYU-Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501, USA.
| | - Justine Lachmann
- Winthrop Cardiology Associates, PC, NYU-Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501, USA
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165
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Axell RG, Giblett JP, White PA, Klein A, Hampton-Til J, O'Sullivan M, Braganza D, Davies WR, West NEJ, Densem CG, Hoole SP. Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies. J Am Heart Assoc 2017; 6:JAHA.117.005820. [PMID: 28588092 PMCID: PMC5669185 DOI: 10.1161/jaha.117.005820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background We sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans. Methods and Results Ten subjects with single‐vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low‐pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia‐induced diastolic dysfunction was seen 1 minute after RP (end‐diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, P<0.001) and BO (end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 8.7±4.0, P=0.03). Impairment of systolic and diastolic function after BO remained at 15‐minutes recovery (ejection fraction [%]: 55.7±9.0 versus 47.8±6.3, P<0.01; end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 9.2±3.9, P<0.01). Persistent diastolic dysfunction was also evident in the RP group at 15‐minutes recovery (end‐diastolic pressure [mm Hg]: 8.1±4.1 versus 9.9±4.4, P=0.03) and there was also sustained impairment of load‐independent indices of systolic function at 15 minutes after RP (end‐systolic elastance and ventriculo‐arterial coupling [mm Hg/mL]: 1.25±0.31 versus 0.85±0.43, P<0.01). Conclusions RP and right coronary artery balloon occlusion both cause ischemic right ventricular dysfunction with stunning observed later during the procedure. This may have intraoperative implications in patients without right ventricular functional reserve.
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Affiliation(s)
- Richard G Axell
- Medical Physics and Clinical Engineering, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom.,Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Joel P Giblett
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom.,Division of Cardiovascular Medicine, University of Cambridge, United Kingdom
| | - Paul A White
- Medical Physics and Clinical Engineering, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom.,Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Andrew Klein
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - James Hampton-Til
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Michael O'Sullivan
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - Denise Braganza
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - William R Davies
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - Nick E J West
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - Cameron G Densem
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
| | - Stephen P Hoole
- Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
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166
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Lakatos B, Tősér Z, Tokodi M, Doronina A, Kosztin A, Muraru D, Badano LP, Kovács A, Merkely B. Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method. Cardiovasc Ultrasound 2017; 15:8. [PMID: 28347344 PMCID: PMC5369196 DOI: 10.1186/s12947-017-0100-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/15/2017] [Indexed: 01/30/2023] Open
Abstract
Three major mechanisms contribute to right ventricular (RV) pump function: (i) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (ii) inward movement of the RV free wall; (iii) bulging of the interventricular septum into the RV and stretching the free wall over the septum. The relative contribution of the aforementioned mechanisms to RV pump function may change in different pathological conditions. Our aim was to develop a custom method to separately assess the extent of longitudinal, radial and anteroposterior displacement of the RV walls and to quantify their relative contribution to global RV ejection fraction using 3D data sets obtained by echocardiography. Accordingly, we decomposed the movement of the exported RV beutel wall in a vertex based manner. The volumes of the beutels accounting for the RV wall motion in only one direction (either longitudinal, radial, or anteroposterior) were calculated at each time frame using the signed tetrahedron method. Then, the relative contribution of the RV wall motion along the three different directions to global RV ejection fraction was calculated either as the ratio of the given direction’s ejection fraction to global ejection fraction and as the frame-by-frame RV volume change (∆V/∆t) along the three motion directions. The ReVISION (Right VentrIcular Separate wall motIon quantificatiON) method may contribute to a better understanding of the pathophysiology of RV mechanical adaptations to different loading conditions and diseases.
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Affiliation(s)
- Bálint Lakatos
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary
| | - Zoltán Tősér
- Department of Software Technology and Methodology, Eötvös Loránd University, Budapest, Hungary
| | - Márton Tokodi
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary
| | - Alexandra Doronina
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary
| | - Annamária Kosztin
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Attila Kovács
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary.
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor St. 68, H-1122, Budapest, Hungary
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167
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Ricci F, Mele D, Bianco F, Bucciarelli V, De Caterina R, Gallina S. Right heart-pulmonary circulation unit and cardiac resynchronization therapy. Am Heart J 2017; 185:1-16. [PMID: 28267462 DOI: 10.1016/j.ahj.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
Clinical response to cardiac resynchronization therapy (CRT) has been known for years to be highly variable, with a spectrum of responses from no change or even deterioration of cardiac function to spectacular improvements. In the plethora of clinical, echocardiographic, biohumoral, and electrophysiological predictors of response to CRT and postimplant issues besides patient selection, the role of right ventricular (RV) function has been largely overlooked. In reviewing current evidence, we noticed conflicting results between observational studies and randomized trials not only concerning the impact of baseline RV function on CRT efficacy but also on the effects of CRT on RV size and function. Hence, we aimed to provide a critical reappraisal of current knowledge and unresolved issues on the reciprocal interactions between RV function and CRT, shifting the spotlight on the concept of right heart pulmonary circulation unit and on the clinical and prognostic significance of impaired ventricular-arterial coupling reserve. In this viewpoint, we propose that (1) CRT should not be denied to potential candidate because of "isolated" RV dysfunction and (2) assessment of baseline right heart pulmonary circulation unit and its dynamic response to pharmacological stress should be considered in future studies, as well as in the preimplant evaluation of individual candidates among other clinical factors.
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Affiliation(s)
- Fabrizio Ricci
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy; Department of Neuroscience and Imaging and ITAB-Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy.
| | - Donato Mele
- Noninvasive Cardiac Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Francesco Bianco
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
| | | | | | - Sabina Gallina
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
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168
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Nagiub M, Filippone S, Durrant D, Das A, Kukreja RC. Long-acting PDE5 inhibitor tadalafil prevents early doxorubicin-induced left ventricle diastolic dysfunction in juvenile mice: potential role of cytoskeletal proteins. Can J Physiol Pharmacol 2017; 95:295-304. [PMID: 28238269 DOI: 10.1139/cjpp-2016-0551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The chemotherapeutic use of doxorubicin (Dox) is hindered due to the development of irreversible cardiotoxicity. Specifically, childhood cancer survivors are at greater risk of Dox-induced cardiovascular complications. Because of the potent cardioprotective effect of phosphodiesterase 5 (PDE5) inhibitors, we examined the effect of long-acting PDE5 inhibitor tadalafil (Tada) against Dox cardiotoxicity in juvenile mice. C57BL/6J mice (6 weeks old) were treated with Dox (20 mg/kg, i.v.) and (or) Tada (10 mg/kg daily for 14 days, p.o.). Cardiac function was assessed by echocardiography following 5 and 10 weeks after Dox treatment. The expression of cardiac proteins was examined by Western blot analysis. Dox treatment caused diastolic dysfunction in juvenile mice indicated by increasing the E/E' (early diastolic myocardial velocity to early tissue Doppler velocity) ratio as compared with control at both 5 and 10 weeks after Dox treatment. Co-treatment of Tada and Dox preserved left ventricular diastolic function with reduction of E/E'. Dox treatment decreased the expression of SERCA2 and desmin in the left ventricle; however, only desmin loss was prevented with Tada. Also, Dox treatment increased the expression of myosin heavy chain (MHCβ), which was reduced by Tada. We propose that Tada could be a promising new therapy for improving cardiac function in survivors of childhood cancer.
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Affiliation(s)
- Mohamed Nagiub
- a Division of Pediatric Cardiology, Department of Pediatrics at Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Scott Filippone
- b Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - David Durrant
- b Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Anindita Das
- b Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Rakesh C Kukreja
- b Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23298, USA
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169
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Hrymak C, Strumpher J, Jacobsohn E. Acute Right Ventricle Failure in the Intensive Care Unit: Assessment and Management. Can J Cardiol 2017; 33:61-71. [DOI: 10.1016/j.cjca.2016.10.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/29/2016] [Accepted: 10/30/2016] [Indexed: 12/29/2022] Open
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170
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D'Andrea A, Limongelli G, Baldini L, Verrengia M, Carbone A, Di Palma E, Vastarella R, Masarone D, Tagliamonte G, Riegler L, Calabrò R, Russo MG, Bossone E, Pacileo G. Exercise speckle-tracking strain imaging demonstrates impaired right ventricular contractile reserve in hypertrophic cardiomyopathy. Int J Cardiol 2017; 227:209-216. [DOI: 10.1016/j.ijcard.2016.11.150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 11/15/2022]
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171
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Chowdhury SM, Goudar SP, Baker GH, Taylor CL, Shirali GS, Friedberg MK, Dragulescu A, Chessa KS, Mertens L. Speckle-Tracking Echocardiographic Measures of Right Ventricular Diastolic Function Correlate with Reference Standard Measures Before and After Preload Alteration in Children. Pediatr Cardiol 2017; 38:27-35. [PMID: 27655413 PMCID: PMC5288273 DOI: 10.1007/s00246-016-1479-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/15/2016] [Indexed: 01/19/2023]
Abstract
The accuracy of echocardiographic measures of right ventricular (RV) diastolic function has been sparsely studied. Our objective was to evaluate the correlation between echocardiographic and reference standard measures of RV diastolic function derived from micromanometer pressure analysis before and after preload alteration in children. Echocardiograms and micromanometer pressure analyses were prospectively performed before and after fluid bolus in children undergoing right heart catheterization. The isovolumic relaxation time constant (τ) and end-diastolic pressure (EDP) were measured. Conventional and speckle-tracking echocardiographic (STE) parameters of RV systolic and diastolic function were assessed. Normal saline bolus was given to increase RV EDP by 20 %. Twenty-eight studies were performed in 22 patients with congenital heart disease or postheart transplantation. Mean age was 8.7 ± 6.1 years. RV longitudinal early diastolic strain rate (EDSR) correlated with τ before (r = 0.57, p = 0.001) and after fluid bolus (r = 0.48, p = 0.008). No conventional echocardiographic measures correlated with τ both before and after fluid bolus. Multiple regression analysis revealed RV EDSR and LV circumferential EDSR as independent predictors of RV τ. There were no independent predictors of EDP. RV EDSR appears to correlate with the reference standard measure of early active ventricular relaxation in children at baseline and after changes in preload. Conventional echocardiographic measures of diastolic function were not predictive of diastolic function after preload alteration. Future studies should assess the prognostic significance of STE measures of diastolic function in this population.
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Affiliation(s)
- Shahryar M. Chowdhury
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Suma P. Goudar
- The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, Missouri
| | - G. Hamilton Baker
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L. Taylor
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S. Shirali
- The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, Missouri
| | - Mark K. Friedberg
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen S. Chessa
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Luc Mertens
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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172
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173
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State of the Art Review of the Right Ventricle in COPD Patients: It is Time to Look Closer. Lung 2016; 195:9-17. [DOI: 10.1007/s00408-016-9961-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
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174
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Fu X, Segiser A, Carrel TP, Tevaearai Stahel HT, Most H. Rat Heterotopic Heart Transplantation Model to Investigate Unloading-Induced Myocardial Remodeling. Front Cardiovasc Med 2016; 3:34. [PMID: 27807535 PMCID: PMC5069686 DOI: 10.3389/fcvm.2016.00034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/20/2016] [Indexed: 12/17/2022] Open
Abstract
Unloading of the failing left ventricle in order to achieve myocardial reverse remodeling and improvement of contractile function has been developed as a strategy with the increasing frequency of implantation of left ventricular assist devices in clinical practice. But, reverse remodeling remains an elusive target, with high variability and exact mechanisms still largely unclear. The small animal model of heterotopic heart transplantation (hHTX) in rodents has been widely implemented to study the effects of complete and partial unloading on cardiac failing and non-failing tissue to better understand the structural and molecular changes that underlie myocardial recovery. We herein review the current knowledge on the effects of volume unloading the left ventricle via different methods of hHTX in rats, differentiating between changes that contribute to functional recovery and adverse effects observed in unloaded myocardium. We focus on methodological aspects of heterotopic transplantation, which increase the correlation between the animal model and the setting of the failing unloaded human heart. Last, but not least, we describe the late use of sophisticated techniques to acquire data, such as small animal MRI and catheterization, as well as ways to assess unloaded hearts under "reloaded" conditions. While giving regard to certain limitations, heterotopic rat heart transplantation certainly represents the crucial model to mimic unloading-induced changes in the heart and as such the intricacies and challenges deserve highest consideration. Careful translational research will further improve our knowledge of the reverse remodeling process and how to potentiate its effect in order to achieve recovery of contractile function in more patients.
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Affiliation(s)
- Xuebin Fu
- Department of Cardiac and Vascular Surgery, Inselspital University Hospital , Berne , Switzerland
| | - Adrian Segiser
- Department of Cardiac and Vascular Surgery, Inselspital University Hospital , Berne , Switzerland
| | - Thierry P Carrel
- Department of Cardiac and Vascular Surgery, Inselspital University Hospital , Berne , Switzerland
| | | | - Henriette Most
- Department of Cardiac and Vascular Surgery, Inselspital University Hospital , Berne , Switzerland
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175
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RV Remodeling in Olympic Athletes. JACC Cardiovasc Imaging 2016; 10:385-393. [PMID: 27544901 DOI: 10.1016/j.jcmg.2016.03.017] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of sex and different sports on right ventricular (RV) remodeling and compare the derived upper limits with widely used revised Task Force (TF) reference values. BACKGROUND Uncertainties exist regarding the extent and physiological determinants of RV remodeling in highly trained athletes. The issue is important, considering that in athletes RV size occasionally exceeds the cutoff limits proposed to diagnose arrhythmogenic RV cardiomyopathy. METHODS A total of 1,009 Olympic athletes (mean age 24 ± 6 years; n = 647 [64%] males) participating in skill, power, mixed, and endurance sport were evaluated by 2-dimensional echocardiography and Doppler/tissue Doppler imaging. The right ventricular outflow tract (RVOT) in parasternal long-axis (PLAX) and short-axis views, fractional area change, s' velocity, and morphological features were assessed. RESULTS Indexed RVOT PLAX was greater in females than in males (15.3 ± 2.2 mm/m2 vs. 14.4 ± 1.9 mm/m2; p < 0.001). Both RVOT PLAX and parasternal short-axis view were significantly different among skill, power, mixed, and endurance sports: 14.3 ± 2.1 mm/m2 versus 14.7 ± 1.9 mm/m2 versus 14.0 ± 1.8 mm/m2 versus 15.7 ± 2.2 mm/m2, respectively (p < 0.001); and 15.2 ± 2.7 mm/m2 versus 15.3 ± 2.4 mm/m2 versus 14.8 ± 2.1 mm/m2 versus 16.2 ± 2.5 mm/m2, respectively (p < 0.001). The 95th percentile for indexed RVOT PLAX and parasternal short-axis view was 18 mm/m2 and 20 mm/m2, respectively. Fractional area change and s' velocity did not differ among the groups (p = 0.34 for both). RV enlargement compatible with major and minor TF diagnostic criteria for arrhythmogenic RV cardiomyopathy was observed in 41 (4%) and 319 (32%) athletes. A rounded apex was described in 823 (81%) athletes, prominent trabeculations in 378 (37%) athletes, and a prominent/hyperreflective moderator band in 5 (0.5%) athletes. CONCLUSIONS RV remodeling occurs in Olympic athletes, with male sex and endurance practice playing the major impact. A significant subset (up to 32%) of athletes exceeds the normal TF limits; therefore, we recommend referring to the 95th percentiles here reported as referral values; alternatively, only major diagnostic TF criteria for arrhythmogenic RV cardiomyopathy may be appropriate.
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176
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Schisler T, Marquez JM, Hilmi I, Subramaniam K. Pulmonary Hypertensive Crisis on Induction of Anesthesia. Semin Cardiothorac Vasc Anesth 2016; 21:105-113. [DOI: 10.1177/1089253216652222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.
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Affiliation(s)
- Travis Schisler
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Jose M Marquez
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Ibtesam Hilmi
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
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177
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Leng S, Jiang M, Zhao XD, Allen JC, Kassab GS, Ouyang RZ, Tan JL, He B, Tan RS, Zhong L. Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking. Ann Biomed Eng 2016; 44:3522-3538. [PMID: 27436293 DOI: 10.1007/s10439-016-1695-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/07/2016] [Indexed: 02/04/2023]
Abstract
Right ventricular (RV) dysfunction is known to be highly correlated with mortality and morbidity; nevertheless, imaging-based assessment of RV anatomy and physiology lags far behind that of the left ventricle. In this study, we advance RV imaging using cardiac magnetic resonance (CMR) to accomplish the following aims: (i) track the motion of six tricuspid annular (TA) sites using a semi-automatic tracking system; (ii) extract clinically important TA measurements-systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), and TA plane systolic excursion (TAPSE)-for each TA site and compare these CMR-derived measurements in healthy subjects vs. patients with heart failure, repaired tetralogy of Fallot, pulmonary hypertension, and hypertrophic cardiomyopathy; (iii) investigate how the TA motion related measurements compare with information provided by invasive right heart catheterization (RHC); (iv) evaluate the rate of change in surface area swept out by the reconstructed tricuspid annulus over time and (v) assess the reproducibility of this CMR-based technique. Results indicate that TA motion parameter data obtained in three dimensions using the proposed CMR-based systematic methodology achieve superior diagnostic performance (Sm: AUC = 0.957; TAPSE: AUC = 0.981) compared to two-dimensional CMR imaging. Both Sm and TAPSE from CMR correlated positively with dP/dt max/IP from RHC (Sm: r = 0.621, p < 0.01; TAPSE: r = 0.648, p < 0.01). Our highly reproducible and robust methodology holds potential for extending CMR imaging to characterization of TA morphology and dynamic behaviour, eventually leading to deeper understanding of RV function and improved diagnostic capability.
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Affiliation(s)
- Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiao-Dan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, 92121, USA
| | - Rong-Zhen Ouyang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ju-Le Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China.
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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178
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The Prognostic Utility of a Simplified Biventricular Echocardiographic Index of Cardiac Remodeling in Patients with Pulmonary Hypertension. J Am Soc Echocardiogr 2016; 29:554-60. [DOI: 10.1016/j.echo.2016.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 11/23/2022]
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179
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Naeije R, D'Alto M. The Diagnostic Challenge of Group 2 Pulmonary Hypertension. Prog Cardiovasc Dis 2016; 59:22-9. [PMID: 27195751 DOI: 10.1016/j.pcad.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 01/22/2023]
Abstract
Pulmonary hypertension (PH) secondary to left heart diseases associated with an increased pulmonary venous pressure is the second of a total of five groups recognized in the classification of PH. Group 2 PH is the commonest form of PH, and is associated with high morbidity and mortality. The diagnosis of group 2 PH relies on a clinical probability assessment in which echocardiography plays a major role, eventually followed by the invasive measurements of a mean pulmonary artery pressure (mPAP) ≥25mmHg and a wedged PAP (PAWP) >15mmHg. This combination of mPAP and PAWP defines "post-capillary PH" (pcPH). Post-capillary PH is most often associated with a diastolic pressure gradient (DPG) or gradient between diastolic PAP and PAWP <7mmHg and/or a pulmonary vascular resistance (PVR) ≤3Wood units (WU), and is called isolated pcPH (IpcPH). Postcapillary PH with a DPG ≥7mmHg and/or a PVR >3WU is then combined pre- and postcapillary PH (CpcPH). Post-capillary PH is associated with a decreased survival in proportion to increased PAP and decreased right ventricular (RV) ejection fraction. CpcPH occurs in 12-13% of patients with pcPH. CpcPH is associated with pulmonary vascular remodeling and altered RV-arterial coupling. The prognosis of CpcPH is poor.
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Affiliation(s)
- Robert Naeije
- Department of Cardiology, Erasme Hospital, Free University of Brussels, Brussels, Belgium.
| | - Michele D'Alto
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
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Native myocardial T1 mapping in pulmonary hypertension: correlations with cardiac function and hemodynamics. Eur Radiol 2016; 27:157-166. [PMID: 27121929 PMCID: PMC5127865 DOI: 10.1007/s00330-016-4360-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 03/04/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Objectives To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics. Methods Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1. Results Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249 ± 58 ms vs. 1186 ± 33 ms, p < 0.0001; lateral, 1190 ± 45 ms vs. 1150 ± 33 ms, p = 0.0003; global, 1220 ± 52 ms vs. 1171 ± 29 ms, p < 0.0001; VIP, 1298 ± 78 ms vs. 1193 ± 31 ms, p < 0.0001). In PH, LV eccentricity index was the strongest linear predictor of VIP T1 (r = 0.72). Septal, lateral and global T1 showed strong correlations with VIP T1 (r = 0.81, r = 0.59 and r = 0.75, respectively). Conclusions In patients with PH, T1 times in VIPs and in the entire LV myocardium are elevated. LV eccentricity strongly correlates with VIP T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium. Key Points • Native T1 mapping detects left ventricular myocardial alterations in pulmonary hypertension • In pulmonary hypertension, native T1 times at ventricular insertion points are increased • These T1 times correlate strongly with left ventricular eccentricity • In pulmonary hypertension, global and segmental myocardial T1 times are increased • Global, segmental and ventricular insertion point T1 times are strongly correlated
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López-Quijano JM, Gordillo-Moscoso A, Viana-Rojas JA, Carrillo-Calvillo J, Mandeville PB, Chevaile-Ramos A. Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients. Cardiorenal Med 2016; 6:230-6. [PMID: 27275159 DOI: 10.1159/000444129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. METHODS A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. RESULTS Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). CONCLUSIONS Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.
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Affiliation(s)
- Juan Manuel López-Quijano
- Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Antonio Gordillo-Moscoso
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Department of Clinical Epidemiology, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Jorge Carrillo-Calvillo
- Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Peter B Mandeville
- Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México; Department of Clinical Epidemiology, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Alejandro Chevaile-Ramos
- Department of Cardiology, Hospital Central 'Dr. Ignacio Morones Prieto', San Luis Potosí, México; Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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Karaye KM, Bonny A. Right ventricular dysfunction in systemic hypertension: A call to action. Int J Cardiol 2016; 206:51-3. [PMID: 26774830 DOI: 10.1016/j.ijcard.2016.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/02/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Aimé Bonny
- Cardiovascular Research Centre, University of Douala, Douala, Cameroon.
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Grinstein J, Gomberg-Maitland M. Management of pulmonary hypertension and right heart failure in the intensive care unit. Curr Hypertens Rep 2016; 17:32. [PMID: 25833459 DOI: 10.1007/s11906-015-0547-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Management of acute right ventricular failure, both with and without coexisting pulmonary hypertension, is a common challenge encountered in the intensive care setting. Both right ventricular dysfunction and pulmonary hypertension portend a poor prognosis, regardless of the underlying cause and are associated with significant morbidity and mortality. The right ventricle is embryologically distinct from the left ventricle and has unique morphologic and functional properties. Management of right ventricular failure and pulmonary hypertension in the intensive care setting requires tailored hemodynamic management, pharmacotherapy, and often mechanical circulatory support. Unfortunately, our understanding of the management of right ventricular failure lags behind that of the left ventricle. In this review, we will explore the underlying pathophysiology of the failing right ventricle and pulmonary vasculature in patients with and without pulmonary hypertension and discuss management strategies based on evidence-based studies as well as our current understanding of the underlying physiology.
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Affiliation(s)
- Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA,
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Muraru D, Onciul S, Peluso D, Soriani N, Cucchini U, Aruta P, Romeo G, Cavalli G, Iliceto S, Badano LP. Sex- and Method-Specific Reference Values for Right Ventricular Strain by 2-Dimensional Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging 2016; 9:e003866. [DOI: 10.1161/circimaging.115.003866] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Denisa Muraru
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Sebastian Onciul
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Diletta Peluso
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Nicola Soriani
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Umberto Cucchini
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Patrizia Aruta
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Gabriella Romeo
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Giacomo Cavalli
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Sabino Iliceto
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
| | - Luigi P. Badano
- From the Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy (D.M., D.P., N.S., U.C., P.A., G.R., G.C., S.I., L.P.B.); and Cardiology Department, Bucharest Emergency Hospital, Bucharest, Romania (S.O.)
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Nielsen EA, Sun M, Honjo O, Hjortdal VE, Redington AN, Friedberg MK. Dual Endothelin Receptor Blockade Abrogates Right Ventricular Remodeling and Biventricular Fibrosis in Isolated Elevated Right Ventricular Afterload. PLoS One 2016; 11:e0146767. [PMID: 26765263 PMCID: PMC4713098 DOI: 10.1371/journal.pone.0146767] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 12/22/2015] [Indexed: 01/11/2023] Open
Abstract
Background Pulmonary arterial hypertension is usually fatal due to right ventricular failure and is frequently associated with co-existing left ventricular dysfunction. Endothelin-1 is a powerful pro-fibrotic mediator and vasoconstrictor that is elevated in pulmonary arterial hypertension. Endothelin receptor blockers are commonly used as pulmonary vasodilators, however their effect on biventricular injury, remodeling and function, despite elevated isolated right ventricular afterload is unknown. Methods Elevated right ventricular afterload was induced by progressive pulmonary artery banding. Seven rabbits underwent pulmonary artery banding without macitentan; 13 received pulmonary artery banding + macitentan; and 5 did not undergo inflation of the pulmonary artery band (sham-operated controls). Results: Right and left ventricular collagen content was increased with pulmonary artery banding compared to sham-operated controls and ameliorated by macitentan. Right ventricular fibrosis signaling (connective tissue growth factor and endothelin-1 protein levels); extra-cellular matrix remodeling (matrix-metalloproteinases 2 and 9), apoptosis and apoptosis-related peptides (caspases 3 and 8) were increased with pulmonary artery banding compared with sham-operated controls and decreased with macitentan. Conclusion Isolated right ventricular afterload causes biventricular fibrosis, right ventricular apoptosis and extra cellular matrix remodeling, mediated by up-regulation of endothelin-1 and connective tissue growth factor signaling. These pathological changes are ameliorated by dual endothelin receptor blockade despite persistent elevated right ventricular afterload.
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Affiliation(s)
- Eva Amalie Nielsen
- Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Mei Sun
- Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Osami Honjo
- Department of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Andrew N. Redington
- Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K. Friedberg
- Department of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
- * E-mail:
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Axell RG, Hoole SP, Hampton-Till J, White PA. RV diastolic dysfunction: time to re-evaluate its importance in heart failure. Heart Fail Rev 2015; 20:363-73. [PMID: 25633340 DOI: 10.1007/s10741-015-9472-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Right ventricular (RV) diastolic dysfunction was first reported as an indicator for the assessment of ventricular dysfunction in heart failure a little over two decades ago. However, the underlying mechanisms and precise role of RV diastolic dysfunction in heart failure remain poorly described. Complexities in the structure and function of the RV make the detailed assessment of the contractile performance challenging when compared to its left ventricular (LV) counterpart. LV dysfunction is known to directly affect patient outcome in heart failure. As such, the focus has therefore been on LV function. Nevertheless, a strategy for the diagnosis and assessment of RV diastolic dysfunction has not been established. Here, we review the different causal mechanisms underlying RV diastolic dysfunction, summarising the current assessment techniques used in a clinical environment. Finally, we explore the role of load-independent indices of RV contractility, derived from the conductance technique, to fully interrogate the RV and expand our knowledge and understanding of RV diastolic dysfunction. Accurate assessment of RV contractility may yield further important prognostic information that will benefit patients with diastolic heart failure.
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Affiliation(s)
- Richard G Axell
- Medical Physics and Clinical Engineering, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK,
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The Right Ventricle: A Comprehensive Review From Anatomy, Physiology, and Mechanics to Hemodynamic, Functional, and Imaging Evaluation. ACTA ACUST UNITED AC 2015. [DOI: 10.5812/acvi.35717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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189
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Burkett DA, Slorach C, Patel SS, Redington AN, Ivy DD, Mertens L, Younoszai AK, Friedberg MK. Left Ventricular Myocardial Function in Children With Pulmonary Hypertension: Relation to Right Ventricular Performance and Hemodynamics. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003260. [PMID: 26259580 DOI: 10.1161/circimaging.115.003260] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular strain, and functional measures of PH. METHODS AND RESULTS At 2 institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. Patients with PH had reduced LV global longitudinal strain (LS; -18.8 [-17.3 to -20.4]% versus -20.2 [-19.0 to -20.9]%; P=0.0046) predominantly because of reduced basal (-12.9 [-10.8 to -16.3]% versus -17.9 [-14.5 to -20.7]%; P<0.0001) and mid (-17.5 [-15.5 to -19.0]% versus -21.1 [-19.1 to -23.0]%; P<0.0001) septal strain. Basal global circumferential strain was reduced (-18.7 [-15.7 to -22.1]% versus -20.6 [-19.0 to -22.5]%; P=0.0098), as were septal and free-wall segments. Mid circumferential strain was reduced within the free-wall. Strain rates were reduced in similar patterns. Basal septum LS, the combined average LS of basal and mid interventricular septal segments, correlated strongly with degree of PH (r=0.66; P<0.0001), pulmonary vascular resistance (r=0.60; P<0.0001), and right ventricular free-wall LS (r=0.64; P<0.0001). Brain natriuretic peptide levels correlated moderately with septal LS (r=0.48; P=0.0038). PH functional class correlated moderately with LV free-wall LS (r=-0.48; P=0.0051). The septum, shared between ventricles and affected by septal shift, was the most affected LV region in PH. CONCLUSIONS Pediatric PH patients demonstrate reduced LV strain/strain rate, predominantly within the septum, with relationships to invasive hemodynamics, right ventricular strain, and functional PH measures.
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Affiliation(s)
- Dale A Burkett
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Cameron Slorach
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Sonali S Patel
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Andrew N Redington
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - D Dunbar Ivy
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Luc Mertens
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Adel K Younoszai
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.)
| | - Mark K Friedberg
- From the Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora (D.A.B., S.S.P., A.K.Y.); and Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (C.S., A.N.R., L.M., M.K.F.).
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Vanden Eynden F, Mets G, De Somer F, Bouchez S, Bove T. Is there a place for intra-aortic balloon counterpulsation support in acute right ventricular failure by pressure-overload? Int J Cardiol 2015; 197:227-34. [DOI: 10.1016/j.ijcard.2015.06.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/07/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022]
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Pulmonary Hypertension and Right Ventricular Failure in Emergency Medicine. Ann Emerg Med 2015; 66:619-28. [PMID: 26342901 DOI: 10.1016/j.annemergmed.2015.07.525] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/08/2015] [Accepted: 07/15/2015] [Indexed: 01/19/2023]
Abstract
Pulmonary hypertension is a hemodynamic condition, defined as a mean pulmonary artery pressure by right-sided heart catheterization of at least 25 mm Hg at rest. It is classified into 5 general groups based on the underlying cause, with left ventricular failure and chronic obstructive pulmonary disease being 2 of the most common causes in the United States. Although the specifics of the pathophysiology will vary with the cause, appreciating the risks of pulmonary hypertension and right ventricular failure is critical to appropriately evaluating and resuscitating pulmonary hypertension patients in the emergency department (ED). Patients may present to the ED with complaints related to pulmonary hypertension or unrelated ones, but this condition will affect all aspects of care. Exertional dyspnea is the most common symptom attributable to pulmonary hypertension, but the latter should be considered in any ED patient with unexplained dyspnea on exertion, syncope, or signs of right ventricular dysfunction. Patients with right ventricular failure are often volume overloaded, and careful volume management is imperative, especially in the setting of hypotension. Vasopressors and inotropes, rather than fluid boluses, are often required in shock to augment cardiac output and reduce the risk of exacerbating right ventricular ischemia. Intubation should be avoided if possible, although hypoxemia and hypercapnia may also worsen right-sided heart function. Emergency physicians should appreciate the role of pulmonary vasodilators in the treatment of pulmonary arterial hypertension and recognize that patients receiving these medications may rapidly develop right ventricular failure and even death without these therapies. Patients may require interventions not readily available in the ED, such as a pulmonary artery catheter, inhaled pulmonary vasodilators, and mechanical support with a right ventricular assist device or extracorporeal membrane oxygenation. Therefore, early consultation with a pulmonary hypertension specialist and transfer to a tertiary care center with invasive monitoring and mechanical support capabilities is advised.
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Right ventricular failure after left ventricular assist devices. J Heart Lung Transplant 2015; 34:1123-30. [DOI: 10.1016/j.healun.2015.06.015] [Citation(s) in RCA: 254] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/11/2015] [Accepted: 06/24/2015] [Indexed: 01/31/2023] Open
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Brede JR. [A woman in her 70s with decompensated heart failure during surgery]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1366-8. [PMID: 26315239 DOI: 10.4045/tidsskr.15.0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Riveros R, Riveros-Perez E. Perioperative Considerations for Children With Right Ventricular Dysfunction and Failing Fontan. Semin Cardiothorac Vasc Anesth 2015; 19:187-202. [PMID: 26287019 DOI: 10.1177/1089253215593178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The survival of patients with congenital heart diseases (CHD) has increased in the past decades, resulting in the identification of new characteristics of chronic comorbidities observed in pediatric and adults with CHD. Patients with CHD can present with a broad clinical spectrum of manifestations of congestive heart failure (CHF) at any point throughout their lives that may be related to anatomical or surgical variables. This article focuses on the perioperative assessment of patients with CHD and CHF, with an emphasis on pathophysiologic, diagnostic, and therapeutic alternatives in patients with right ventricular failure and failing Fontan circulation. We also provide descriptions of the effects of sedatives and anesthetics commonly used in this population in diagnostic or invasive procedures.
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Grapsa J, Pereira Nunes MC, Tan TC, Cabrita IZ, Coulter T, Smith BCF, Dawson D, Gibbs JSR, Nihoyannopoulos P. Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension: Seven-Year Follow-Up. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002107. [PMID: 26063743 DOI: 10.1161/circimaging.114.002107] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In this study, we looked at the prognostic value of echocardiographic and hemodynamic measures in a large cohort of patients with precapillary pulmonary hypertension before and after initiation of treatment. METHODS AND RESULTS Data were collected prospectively in a cohort of consecutive patients with precapillary pulmonary hypertension referred between 2002 and 2011. A range of clinical and echocardiographic variables were collected and stored on a database to assess predictors of survival. Invasive hemodynamic data including pulmonary artery pressure, pulmonary vascular resistance, capillary wedge pressure, and cardiac index were also obtained at baseline in all patients. Outcome was defined as mortality because of cardiovascular-related death. The study cohort comprised 777 patients (514 women) with precapillary pulmonary hypertension. A total of 195 (25%) died. In multivariable analysis, moderate or severe tricuspid regurgitation (hazard ratio [HR], 26.537; 95% confidence interval, 11.536-61.044; P<0.001), right ventricular myocardial performance index (HR, 3.421; 95% confidence interval, 1.777-6.584; P<0.001), and the presence of pericardial effusion (HR, 1.38; 95% confidence interval, 1.023-1.862; P=0.035) were independent predictors of mortality. High pulmonary vascular resistance and right atrial pressure by invasive hemodynamic measurements were independent predictors of mortality (HR, 1.084; 95% confidence interval, 1.041-1.130, and 1.079, respectively; 95% confidence interval, 1.049-1.111; P<0.001 for both), whereas patients with a higher cardiac index had better survival overall (HR, 0.384; 95% confidence interval, 0.307-0.481; P<0.001). CONCLUSIONS Right ventricular dysfunction, moderate-severe tricuspid regurgitation, low cardiac index, and raised right atrial pressure were associated with poor survival for both pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertensive disease patients. The severity of tricuspid regurgitation, myocardial performance index, presence of pericardial effusion, pulmonary vascular resistance, cardiac index, and right atrial pressure may be used to stratify risk of death.
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Affiliation(s)
- Julia Grapsa
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Maria Carmo Pereira Nunes
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Timothy C Tan
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Ines Zimbarra Cabrita
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Taryn Coulter
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Benjamin C F Smith
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - David Dawson
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - J Simon R Gibbs
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.)
| | - Petros Nihoyannopoulos
- From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
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Abstract
Pulmonary arterial hypertension (PAH) is a right heart failure syndrome. In early-stage PAH, the right ventricle tends to remain adapted to afterload with increased contractility and little or no increase in right heart chamber dimensions. However, less than optimal right ventricular (RV)-arterial coupling may already cause a decreased aerobic exercise capacity by limiting maximum cardiac output. In more advanced stages, RV systolic function cannot remain matched to afterload and dilatation of the right heart chamber progressively develops. In addition, diastolic dysfunction occurs due to myocardial fibrosis and sarcomeric stiffening. All these changes lead to limitation of RV flow output, increased right-sided filling pressures and under-filling of the left ventricle, with eventual decrease in systemic blood pressure and altered systolic ventricular interaction. These pathophysiological changes account for exertional dyspnoea and systemic venous congestion typical of PAH. Complete evaluation of RV failure requires echocardiographic or magnetic resonance imaging, and right heart catheterisation measurements. Treatment of RV failure in PAH relies on: decreasing afterload with drugs targeting pulmonary circulation; fluid management to optimise ventricular diastolic interactions; and inotropic interventions to reverse cardiogenic shock. To date, there has been no report of the efficacy of drug treatments that specifically target the right ventricle.
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Affiliation(s)
- Robert Naeije
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium. Dept of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy.
| | - Alessandra Manes
- Dept of Cardiology, Erasme University Hospital, Brussels, Belgium. Dept of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy
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197
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Lemarié J, Huttin O, Girerd N, Mandry D, Juillière Y, Moulin F, Lemoine S, Beaumont M, Marie PY, Selton-Suty C. Usefulness of Speckle-Tracking Imaging for Right Ventricular Assessment after Acute Myocardial Infarction: A Magnetic Resonance Imaging/Echocardiographic Comparison within the Relation between Aldosterone and Cardiac Remodeling after Myocardial Infarction Study. J Am Soc Echocardiogr 2015; 28:818-27.e4. [DOI: 10.1016/j.echo.2015.02.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Indexed: 10/23/2022]
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198
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Bellofiore A, Wang Z, Chesler NC. What does the time constant of the pulmonary circulation tell us about the progression of right ventricular dysfunction in pulmonary arterial hypertension? Pulm Circ 2015; 5:291-5. [PMID: 26064453 PMCID: PMC4449239 DOI: 10.1086/680358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 12/30/2014] [Indexed: 01/07/2023] Open
Abstract
Compliance (C) and resistance (R) maintain a unique, inverse relationship in the pulmonary circulation, resulting in a constant characteristic time [Formula: see text] that has been observed in healthy subjects as well as patients with pulmonary arterial hypertension (PAH). However, little is known about the dependence of right ventricular (RV) function on the coupled changes in R and C in the context of this inverse relationship. We hypothesized three simple dependencies of RV ejection fraction (RVEF) on R and C. The first model (linear-R) assumes a linear RVEF-R relation; the second (linear-C) assumes a linear RVEF-C relation; and the third one combines the former two in a mixed linear model. We found that the linear-R model and the mixed linear model are in good agreement with clinical evidence. A conclusive validation of these models will require more clinical data. Longitudinal data in particular are needed to identify the time course of ventricular-vascular impairment in PAH. Simple models like the ones we present here, once validated, will advance our understanding of the mechanisms of RV failure, which could improve strategies to manage RV dysfunction in PAH.
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Affiliation(s)
- A Bellofiore
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA ; Department of Biomedical, Chemical, and Materials Engineering, San Jose State University, San Jose, California, USA ; These authors contributed equally
| | - Z Wang
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA ; These authors contributed equally
| | - N C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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199
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The Unnatural History of the Ventricular Septal Defect. J Am Coll Cardiol 2015; 65:1941-51. [DOI: 10.1016/j.jacc.2015.02.055] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/20/2022]
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200
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Koprivanac M, Kelava M, Sirić F, Cruz VB, Moazami N, Mihaljević T. Predictors of right ventricular failure after left ventricular assist device implantation. Croat Med J 2015; 55:587-95. [PMID: 25559829 PMCID: PMC4295071 DOI: 10.3325/cmj.2014.55.587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, different types of LVADs, and differences in patient populations included in studies. RVF complicating LVAD implantation is associated with worse postoperative mortality and morbidity including worse end-organ function, longer hospital length of stay, and lower success of bridge to transplant (BTT) therapy. Importance of RVF and its predictors in a setting of LVAD implantation has been recognized early, as evidenced by abundant number of attempts to identify independent risk factors and develop RVF predictor scores with a common purpose to improve patient selection and outcomes by recognizing potential need for biventricular assist device (BiVAD) at the time of LVAD implantation. The aim of this article is to review and summarize current body of knowledge on risk factors and prediction scores of RVF after LVAD implantation. Despite abundance of studies and proposed risk scores for RVF following LVAD, certain common limitations make their implementation and clinical usefulness questionable. Regardless, value of these studies lies in providing information on potential key predictors for RVF that can be taken into account in clinical decision making. Further investigation of current predictors and existing scores as well as new studies involving larger patient populations and more sophisticated statistical prediction models are necessary. Additionally, a short description of our empirical institutional approach to management of RVF following LVAD implantation is provided.
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Affiliation(s)
- Marijan Koprivanac
- Marijan Koprivanac, Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Baniyas Towers, Abu Dhabi, United Arab Emirates,
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