1
|
Kim M, Uhm JS, Park JW, Bae S, Jung IH, Heo SJ, Kim D, Yu HT, Kim TH, Joung B, Lee MH. The Effects of Radiofrequency Catheter Ablation for Atrial Fibrillation on Right Ventricular Function. Korean Circ J 2024; 54:203-217. [PMID: 38654567 PMCID: PMC11040267 DOI: 10.4070/kcj.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The effects of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) on right ventricular (RV) function are not well known. METHODS Patients who underwent RFCA for AF and underwent pre- and post-procedural echocardiography were enrolled consecutively. Fractional area change (FAC), RV free-wall longitudinal strain (RVFWSL), and RV 4-chamber strain including the ventricular septum (RV4CSL) were measured. Changes in FAC, RVFWSL, and RV4CSL before and after RFCA were compared among paroxysmal AF (PAF), persistent AF (PeAF), and long-standing persistent AF (LSPeAF) groups. RESULTS A total of 164 participants (74 PAF, 47 PeAF, and 43 LSPeAF; age, 60.8 ± 9.8 years; men, 74.4%) was enrolled. The patients with PeAF and LSPeAF had worse RV4CSL (p<0.001) and RVFWSL (p<0.001) than those with PAF and reference values. Improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared with the PAF and LSPeAF groups (ΔRV4CSL, 8.4% [5.1, 11.6] in PeAF vs. 1.0% [-1.0, 4.1] in PAF, 1.9% [-0.2, 4.4] in LSPeAF, p<0.001; ΔRVFWSL, 9.0% [6.9, 11.5] in PeAF vs. 0.9% [-1.4, 4.9] in PAF, 1.0% [-1.0, 3.6] in LSPeAF, p<0.001). In patients without recurrence, improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared to the LSPeAF group. CONCLUSIONS RV systolic function is more impaired in patients with PeAF and LSPeAF than in those with PAF. RV systolic function is more improved after RFCA in patients with PeAF than in those with PAF or LSPeAF.
Collapse
Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Vieira JS, Cunha TF, Paixão NA, Dourado PM, Carrascoza LS, Bacurau AVN, Brum PC. Exercise intolerance establishment in pulmonary hypertension: Preventive effect of aerobic exercise training. Life Sci 2020; 261:118298. [PMID: 32822717 DOI: 10.1016/j.lfs.2020.118298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
AIMS 1) Characterize the progression of exercise intolerance in monocrotaline-induced pulmonary hypertension (PH) in mice and 2) evaluate the therapeutic effect of aerobic exercise training (AET) on counteracting skeletal and cardiac dysfunction in PH. MAIN METHODS Wild type C57BL6/J mice were studied in two different time points: 2 months and 4 months. Exercise tolerance was evaluated by graded treadmill exercise test. The AET was performed in the last month of treatment of 4 months' time point. Cardiac function was evaluated by echocardiography. Skeletal muscle cross-sectional area was assessed by immunofluorescence. The diameter of cardiomyocytes and pulmonary edema were quantified by staining with hematoxylin-eosin. The variables were compared among the groups by two-way ANOVA or non-paired Student's t-test. Significance level was set at p < 0.05. KEY FINDINGS After 2 months of MCT treatment, mice presented pulmonary edema, right cardiac dysfunction and left ventricle hypertrophy. After 4 months of MCT treatment, mice showed pulmonary edema, right and left cardiac dysfunction and remodeling associated with exercise intolerance and skeletal muscle atrophy. AET was able to reverse cardiac left ventricle dysfunction and remodeling, prevent exercise intolerance and skeletal muscle dysfunction. Thus, our data provide evidence of skeletal muscle abnormalities on advanced PH. AET was efficient in inducing an anti-cardiac remodeling effect besides preventing exercise intolerance. SIGNIFICANCE Our study provides a robust model of PH in mice, as well as highlights the importance of AET as a preventive strategy for exercise intolerance and, skeletal and cardiac muscle abnormalities in PH.
Collapse
Affiliation(s)
- J S Vieira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - T F Cunha
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - N A Paixão
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - P M Dourado
- Heart Institute, Medical School, University of São Paulo, São Paulo, Brazil
| | - L S Carrascoza
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - A V N Bacurau
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - P C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
3
|
Cameli M, Mandoli GE, Ambrosio G, Cerbai E, Coiro S, Emdin M, Marcucci R, Morrone D, Palazzuoli A, Savino K, Padeletti L, Mondillo S, Pedrinelli R. Arterial hypertension and atrial fibrillation: standard and advanced echocardiography from diagnosis to prognostication. J Cardiovasc Med (Hagerstown) 2018; 19:51-61. [PMID: 29251696 DOI: 10.2459/jcm.0000000000000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Structural changes in left and right cardiac chambers that occur in arterial hypertension (AH) may lead to an increased risk of atrial fibrillation. Considering that AH is currently the most common cardiovascular disease in the general population, it represents a major risk factor for atrial fibrillation development. This review explores the complex relationship between atrial fibrillation and AH, starting from its pathophysiological basis. It focuses on the role of echocardiography in the management of hypertensive and atrial fibrillation patients, with emphasis on what should be evaluated about left ventricular remodeling, diastolic and systolic function, left atrial (LA) size and function and right ventricular deformation in patients with AH.
Collapse
Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giulia E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Florence
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Michele Emdin
- Scuola Superiore Sant'Anna.,Fondazione Toscana G. Monasterio, Pisa
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Doralisa Morrone
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Siena
| | - Ketty Savino
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Luigi Padeletti
- Institute of Internal Medicine and Cardiology, Careggi Hospital, University of Florence, Florence.,IRCCS Multimedica, Milan, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
| | | |
Collapse
|
4
|
Long-Term Chronic Intermittent Hypobaric Hypoxia in Rats Causes an Imbalance in the Asymmetric Dimethylarginine/Nitric Oxide Pathway and ROS Activity: A Possible Synergistic Mechanism for Altitude Pulmonary Hypertension? Pulm Med 2016; 2016:6578578. [PMID: 27313889 PMCID: PMC4904121 DOI: 10.1155/2016/6578578] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/08/2016] [Indexed: 12/28/2022] Open
Abstract
Chronic intermittent hypoxia (CIH) and chronic hypoxia (CH) are associated with high-altitude pulmonary hypertension (HAPH). Asymmetric dimethylarginine (ADMA), a NO synthase (NOS) inhibitor, may contribute to HAPH. This study assessed changes in the ADMA/NO pathway and the underlying mechanisms in rat lungs following exposure to CIH or CH simulated in a hypobaric chamber at 428 Torr. Twenty-four adult Wistar rats were randomly assigned to three groups: CIH2x2 (2 days of hypoxia/2 days of normoxia), CH, and NX (permanent normoxia), for 30 days. All analyses were performed in whole lung tissue. L-Arginine and ADMA were analyzed using LC-MS/MS. Under both hypoxic conditions right ventricular hypertrophy was observed (p < 0.01) and endothelial NOS mRNA increased (p < 0.001), but the phosphorylated/nonphosphorylated vasodilator-stimulated phosphoprotein (VASP) ratio was unchanged. ADMA increased (p < 0.001), whereas dimethylarginine dimethylaminohydrolase (DDAH) activity decreased only under CH (p < 0.05). Although arginase activity increased (p < 0.001) and L-arginine exhibited no changes, the L-arginine/ADMA ratio decreased significantly (p < 0.001). Moreover, NOX4 expression increased only under CH (p < 0.01), but malondialdehyde (MDA) increased (up to 2-fold) equally in CIH2x2 and CH (p < 0.001). Our results suggest that ADMA and oxidative stress likely reduce NO bioavailability under altitude hypoxia, which implies greater pulmonary vascular reactivity and tone, despite the more subdued effects observed under CIH.
Collapse
|
5
|
Donal E, Lip GYH, Galderisi M, Goette A, Shah D, Marwan M, Lederlin M, Mondillo S, Edvardsen T, Sitges M, Grapsa J, Garbi M, Senior R, Gimelli A, Potpara TS, Van Gelder IC, Gorenek B, Mabo P, Lancellotti P, Kuck KH, Popescu BA, Hindricks G, Habib G, Cosyns B, Delgado V, Haugaa KH, Muraru D, Nieman K, Cohen A. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016; 17:355-83. [DOI: 10.1093/ehjci/jev354] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
6
|
Adventitial alterations are the main features in pulmonary artery remodeling due to long-term chronic intermittent hypobaric hypoxia in rats. BIOMED RESEARCH INTERNATIONAL 2015; 2015:169841. [PMID: 25738150 PMCID: PMC4337174 DOI: 10.1155/2015/169841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/21/2014] [Accepted: 11/05/2014] [Indexed: 11/17/2022]
Abstract
Long-term chronic intermittent exposure to altitude hypoxia is a labor phenomenon requiring further research. Using a rat model, we examined whether this type of exposure differed from chronic exposure in terms of pulmonary artery remodeling and other features. Rats were subjected to chronic hypoxia (CH, n = 9) and long-term intermittent hypoxia (CIH2x2; 2 days of hypoxia/2 days of normoxia, n = 10) in a chamber (428 Torr, 4,600 m of altitude) for 46 days and compared to rats under normoxia (NX, n = 10). Body weight, hematocrit, and right ventricle ratio were measured. Pulmonary artery remodeling was assessed using confocal microscopy of tissues stained with a nuclear dye (DAPI) and CD11b antibody. Both hypoxic conditions exhibited increased hematocrit and hypertrophy of the right ventricle, tunica adventitia, and tunica media, with no changes in lumen size. The medial hypertrophy area (larger in CH) depicted a significant increase in smooth muscle cell number. Additionally, CIH2x2 increased the adventitial hypertrophy area, with an increased cellularity and a larger prevalence of clustered inflammatory cells. In conclusion, CIH2x2 elicits milder effects on pulmonary artery medial layer muscularization and subsequent right ventricular hypertrophy than CH. However, CIH2x2 induces greater and characteristic alterations of the adventitial layer.
Collapse
|
7
|
Kim KH, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Kang JC. Acute right heart failure caused by iatrogenic brachiocephalic arteriovenous fistula following orthopedic surgery. Korean J Intern Med 2014; 29:529-31. [PMID: 25045302 PMCID: PMC4101601 DOI: 10.3904/kjim.2014.29.4.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/04/2008] [Accepted: 12/11/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kye Hun Kim
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Ju Yoon
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center, Chonnam National University Hospital, and The Research Institute of Medical Science, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
8
|
Tuder RM, Robinson JC, Graham BB. Fat and cardiotoxicity in hereditary pulmonary hypertension. Am J Respir Crit Care Med 2014; 189:247-9. [PMID: 24484329 DOI: 10.1164/rccm.201312-2240ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rubin M Tuder
- 1 Division of Pulmonary Sciences and Critical Care Medicine University of Colorado School of Medicine Aurora, Colorado
| | | | | |
Collapse
|
9
|
Abstract
Recent clinical and experimental studies are redefining the cellular and molecular bases of pulmonary arterial hypertension (PAH). The genetic abnormalities first identified in association with the idiopathic form of PAH--together with a vast increase in our understanding of cell signaling, cell transformation, and cell-cell interactions; gene expression; microRNA processing; and mitochondrial and ion channel function--have helped explain the abnormal response of vascular cells to injury. Experimental and clinical studies now converge on the intersection and interactions between a genetic predisposition involving the BMPR2 signaling pathway and an impaired metabolic and chronic inflammatory state in the vessel wall. These deranged processes culminate in an exuberant proliferative response that occludes the pulmonary arterial (PA) lumen and obliterates the most distal intraacinar vessels. Here, we describe emerging therapies based on preclinical studies that address these converging pathways.
Collapse
Affiliation(s)
- Marlene Rabinovitch
- Stanford University School of Medicine, Stanford, California 94305-5162, USA.
| |
Collapse
|
10
|
Tonelli AR, Yadav R, Gupta A, Arrossi AV, Heresi GA, Dweik RA. Spleen size in idiopathic and heritable pulmonary arterial hypertension. ACTA ACUST UNITED AC 2012; 85:391-9. [PMID: 22869505 DOI: 10.1159/000339423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 05/10/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unknown whether the spleen size correlates with disease severity and outcome in patients with idiopathic and heritable pulmonary arterial hypertension (PAH). OBJECTIVES To determine the prevalence of splenomegaly in PAH and assess whether it correlates with severity of disease and outcome. METHODS We identified subjects with either heritable or idiopathic PAH who had Doppler echocardiography, right-heart catheterization and computed tomography (CT) of the chest and/or abdomen that included the spleen. RESULTS We included 62 subjects with a mean age (±SD) of 49 (±15) years; 82% were women. Spleen dimensions were 10 (±3), 6 (±2) and 9 (±2) cm for the craniocaudal length, thickness and width measurements, respectively. The median [interquartile range (IQR)] spleen volume was 344 (225-533) cm3. Splenomegaly was observed in 52-63% of the patients, depending on the formula used. The spleen volume was not associated with clinical, echocardiographic or hemodynamic variables. Spleen volume was not associated with adjusted mortality. We studied the characteristics of the spleen during autopsy in 9 patients with idiopathic PAH who died of right-heart failure. The mean (IQR) spleen weight was 220 (151-325) g. We observed early congestion in all but 2 patients who had chronic congestion. CONCLUSIONS Splenomegaly of predominantly mild degree is common in idiopathic and heritable PAH. However, spleen size was not associated with clinical, echocardiographic, hemodynamic and survival data in these patients.
Collapse
Affiliation(s)
- Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland, Ohio, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Cappelli F, Porciani MC, Bergesio F, Perlini S, Attana P, Moggi Pignone A, Salinaro F, Musca F, Padeletti L, Perfetto F. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging 2011; 13:416-22. [DOI: 10.1093/ejechocard/jer289] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Segovia J, Bermejo J, Alfonso F, Heras M. The right heart and pulmonary circulation: is it really a minor circulation? Rev Esp Cardiol 2010; 63:77-80. [PMID: 20089228 DOI: 10.1016/s1885-5857(10)70011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
13
|
Segovia J, Bermejo J, Alfonso F, Heras M. Corazón derecho y circulación pulmonar: ¿una circulación menor? Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70011-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Relation of circulating markers of fibrosis and progression of left and right ventricular dysfunction in hypertensive patients with heart failure. J Hypertens 2009; 27:2483-91. [DOI: 10.1097/hjh.0b013e3283316c4d] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
|
16
|
NT-proBNP levels in the evaluation of right ventricular dysfunction in patients with coronary artery disease and abnormal left ventricular wall motion: a magnetic resonance imaging study. Coron Artery Dis 2009; 19:481-7. [PMID: 18923244 DOI: 10.1097/mca.0b013e32830b4d0e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data available on the correlation of N-terminal probrain natriuretic peptide (NT-proBNP) levels and right ventricular (RV) function in patients with coronary artery disease (CAD) are limited. OBJECTIVE To determine the relation between plasma NT-proBNP and RV function in patients with CAD and abnormal left ventricular (LV) wall motion. METHODS This is a cross-sectional study. We studied 176 patients with CAD and abnormal LV wall motion. All patients underwent cardiac magnetic resonance imaging for the assessment of LV and RV function and plasma NT-proBNP analysis on the same day. Multivariable analysis was performed to evaluate the independent factors associated with RV dysfunction. Receiver-operating characteristic analysis was used to assess the use of NT-proBNP levels for the diagnosis of LV and RV dysfunction. RESULTS Average LV ejection fraction (LVEF) and RV ejection fraction were 37.6 and 52.0%, respectively. Median levels of NT-proBNP were 978 pg/ml. Log NT-proBNP levels had a positive correlation with age, LV and RV volume, LV and RV mass, and had a negative correlation with body size, creatinine clearance, LVEF, and RV ejection fraction. From a multivariable analysis, log NT-proBNP levels and LVEF were independently associated with RV dysfunction. From receiver-operating characteristic analysis, NT-proBNP at the levels of 1706 and 378 pg/ml was shown to detect RV dysfunction and LV dysfunction at an accuracy of 80.7 and 77.8% and area under the curve of 0.837 and 0.765, respectively. CONCLUSION NT-proBNP levels can be used to diagnose RV dysfunction in patients with CAD and abnormal LV wall motion.
Collapse
|
17
|
Abstract
Recent investigations have suggested that it might be possible to reverse the pathology of pulmonary arterial hypertension (PAH), a disorder that can be rapidly progressive and fatal despite current treatments including i.v. prostacyclin. This review will address the cellular and molecular processes implicated in clinical, genetic, and experimental studies as underlying the pulmonary vascular abnormalities associated with PAH. Emerging treatments are aimed at inducing apoptosis of abnormal vascular cells that obstruct blood flow and at promoting regeneration of "lost" distal vasculature.
Collapse
Affiliation(s)
- Marlene Rabinovitch
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California 94305-5162, USA.
| |
Collapse
|
18
|
Abstract
The heart is one of the major organs involved in scleroderma, the involvement of which can be manifested by myocardial disease, conduction system abnormalities, arrhythmias, or pericardial disease. Additionally, scleroderma renal crisis and pulmonary hypertension lead to significant cardiac dysfunction secondary to damage in the kidney and lung. This article summarizes the types and mechanism of abnormalities in the heart in scleroderma. The concept of cardiac dysfunction in scleroderma and other rheumatologic conditions has received new interest with the advent of newer noninvasive imaging techniques, as well as the interest in detecting subclinical disease. With this increased interest in cardiac manifestations in scleroderma comes the realization that long-term studies are needed to better assess the appropriate screening and treatment in this patient population.
Collapse
|
19
|
Rajagopalan N, Simon MA, Shah H, Mathier MA, López-Candales A. Utility of right ventricular tissue Doppler imaging: correlation with right heart catheterization. Echocardiography 2008; 25:706-11. [PMID: 18445057 DOI: 10.1111/j.1540-8175.2008.00689.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objective of this study was to correlate tissue Doppler imaging of the right ventricle (RV) with pulmonary hemodynamics in patients referred for right heart catheterization. METHODS Seventy subjects (mean age 54 +/- 13; 35 males) prospectively underwent tissue Doppler imaging of the RV and right heart catheterization within 1 day of each other. Peak systolic velocity and strain were measured at the RV free wall and correlated with pulmonary hemodynamics. RESULTS RV myocardial velocity demonstrated no correlation with any hemodynamic variable. While RV strain demonstrated significant correlation with cardiac index (r =-0.61; P < 0.001), correlations with transpulmonary gradient (r = 0.26; P < 0.05) and pulmonary vascular resistance (r = 0.30; P < 0.05) were weaker. Subgroup analysis revealed that in patients with left ventricular systolic dysfunction (n = 31), RV strain showed no correlation with any hemodynamic variable. In patients with normal left ventricular systolic function (n = 39), correlations were significant between RV strain and mean pulmonary artery pressure (r = 0.59; P < 0.001), pulmonary vascular resistance (r = 0.60; P < 0.001), and cardiac index (r =-0.67; P < 0.001). CONCLUSIONS RV myocardial strain correlates significantly with pulmonary hemodynamics in patients with pulmonary hypertension and normal left ventricular function. However, there is no correlation with RV performance in patients with left ventricular dysfunction.
Collapse
Affiliation(s)
- Navin Rajagopalan
- Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15513-2582, USA.
| | | | | | | | | |
Collapse
|
20
|
Kim GB, Noh CI. Intensive management of acute right heart failure. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.11.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chung Il Noh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|