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Fukumitsu M, Kawada T, Nishikawa T, Yokota S, Matsushita H, Morita H, Sato K, Yoshida Y, Uemura K, Saku K. Effects of nitric oxide inhalation on pulmonary arterial impedance: differences between normal and pulmonary hypertension male rats. Am J Physiol Heart Circ Physiol 2024; 327:H000. [PMID: 38819383 DOI: 10.1152/ajpheart.00108.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
Nitric oxide (NO) inhalation improves pulmonary hemodynamics in participants with pulmonary arterial hypertension (PAH). Although it can reduce pulmonary vascular resistance (PVR) in PAH, its impact on the dynamic mechanics of pulmonary arteries and its potential difference between control and participants with PAH remain unclear. PA impedance provides a comprehensive description of PA mechanics. With an arterial model, PA impedance can be parameterized into peripheral pulmonary resistance (Rp), arterial compliance (Cp), characteristic impedance of the proximal arteries (Zc), and transmission time from the main PA to the reflection site. This study investigated the effects of inhaled NO on PA impedance and its associated parameters in control and monocrotaline-induced pulmonary arterial hypertension (MCT-PAH) male rats (6/group). Measurements were obtained at baseline and during NO inhalation at 40 and 80 ppm. In both groups, NO inhalation decreased PVR and increased the left atrial pressure. Notably, its impact on PA impedance was frequency dependent, as revealed by reduced PA impedance modulus in the low-frequency range below 10 Hz, with little effect on the high-frequency range. Furthermore, NO inhalation attenuated Rp, increased Cp, and prolonged transmission time without affecting Zc. It reduced Rp more pronouncedly in MCT-PAH rats, whereas it increased Cp and delayed transmission time more effectively in control rats. In conclusion, the therapeutic effects of inhaled NO on PA impedance were frequency dependent and may differ between the control and MCT-PAH groups, suggesting that the effect on the mechanics differs depending on the pathological state.NEW & NOTEWORTHY Nitric oxide inhalation decreased pulmonary arterial impedance in the low-frequency range (<10 Hz) with little impact on the high-frequency range. It reduced peripheral pulmonary resistance more pronouncedly in pulmonary hypertension rats, whereas it increased arterial compliance and transmission time in control rats. Its effect on the mechanics of the pulmonary arteries may differ depending on the pathological status.
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Affiliation(s)
- Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuya Nishikawa
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shohei Yokota
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroki Matsushita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hidetaka Morita
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kei Sato
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Yoshida
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
- NTTR-NCVC Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
- NTTR-NCVC Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, Japan
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Yoshida T, Uejima T, Komeda S, Matsuura K, Uemura A, Hayama H, Yamashita T, Yilmaz Z, Tanaka R. Estimation of Pulmonary Arterial Wave Reflection by Echo-Doppler: A Preliminary Study in Dogs With Experimentally-Induced Acute Pulmonary Embolism. Front Physiol 2021; 12:752550. [PMID: 34955877 PMCID: PMC8692872 DOI: 10.3389/fphys.2021.752550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Pulmonary arterial (PA) wave reflection provides additional information for assessing right ventricular afterload, but its applications is hampered by the need for invasive pressure and flow measurements. We tested the hypothesis that PA pressure and flow waveforms estimated by Doppler echocardiography could be used to quantify PA wave reflection. Methods: Doppler echocardiographic images of tricuspid regurgitation and right ventricular outflow tract flow used to estimate PA pressure and flow waveforms were acquired simultaneously with direct measurements with a dual sensor-tipped catheter under various hemodynamic conditions in a canine model of pulmonary hypertension (n = 8). Wave separation analysis was performed on echo-Doppler derived as well as catheter derived waveforms to separate PA pressure into forward (Pf) and backward (Pb) pressures and derive wave reflection coefficient (RC) defined as the ratio of peak Pb to peak Pf. Results: Wave reflection indices by echo-Doppler agreed well with corresponding indices by catheter (Pb: mean difference = 0.4 mmHg, 95% limits of agreement = −4.3 to 5.0 mmHg; RC: bias = 0.13, 95% limits of agreement = −0.25 to 0.26). RC correlated negatively with PA compliance. Conclusion: This echo-Doppler method yields reasonable measurement of reflected wave in the pulmonary circulation, paving the way to a more integrative assessment of pulmonary hemodynamics in the clinical setting.
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Affiliation(s)
- Tomohiko Yoshida
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | | | - Syunta Komeda
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Katsuhiro Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Akiko Uemura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Hiromasa Hayama
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Zeki Yilmaz
- Department of Veterinary Internal Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
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Yoshida T, Shimada K, Hamabe L, Uchide T, Tanaka R, Matsuura K. Measurement of Pulmonary Artery Wave Reflection Before and After Mitral Valvuloplasty in Canine Patients With Pulmonary Hypertension Caused by Myxomatous Mitral Valve Disease. Front Vet Sci 2021; 8:773035. [PMID: 34926644 PMCID: PMC8674487 DOI: 10.3389/fvets.2021.773035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/05/2021] [Indexed: 01/29/2023] Open
Abstract
Background: Pulmonary arterial wave reflection provides novel information about pulmonary artery hemodynamics in pulmonary hypertension (PH). PH is common in dogs with myxomatous mitral valve disease (MMVD), though research examining the relationship between pulmonary arterial wave reflection and MMVD with PH is lacking. Hypothesis/Objective: This study investigated conventional echocardiographic parameters and pulmonary artery wave reflection parameters before and after mitral valvuloplasty in canine patients with PH due to MMVD. The parameters were backward pressure (Pb), forward pressure (Pf), and the reflection coefficient calculated as the ratio of peak Pb to peak Pf (RC). Animals: The study subjects were 10 client-owned dogs receiving mitral valvuloplasty for MMVD with PH. Methods: Conventional echocardiographic parameters and pulmonary artery wave reflection parameters were measured before and after mitral valvuloplasty. The relationships between pulmonary artery wave reflection parameters and echocardiographic parameters, estimation of pulmonary artery systolic pressure, and right atrium pressure (RAP) gained by catheter in mitral valvuloplasty were also investigated. Post-operative echocardiography and the measurement of pulmonary arterial wave reflection were performed 2 weeks after mitral valvuloplasty. Results: The parameters of normalized left ventricular internal diameter at end-diastole (LVIDDN), E velocity, and the estimation of pulmonary artery systolic pressure were significantly reduced post-operatively compared with baseline measurements (p < 0.05). Post-operative Pb decreased significantly compared with pre-operative measurements (8.8 ± 5.9 to 5.0 ± 3.2 mmHg, p = 0.037) as did RC (0.37 ± 0.15 to 0.22 ± 0.11, p < 0.01). A statistically significant positive correlation existed between wave reflection parameters and RAP, an estimation of pulmonary artery systolic pressure. Conclusions: Results demonstrate that mitral valvuloplasty can be used to treat secondary PH caused by MMVD, resulting in the improvement of post-operative echocardiographic and wave reflection parameters and a decrease in the right afterload. In some patients, some degree of vascular admittance mismatch persisted, despite the improvement of left atrial pressure. This may be indicative of residual pulmonary arterial disease, which may continue to adversely affect interactions between the right ventricle and the vasculature.
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Affiliation(s)
- Tomohiko Yoshida
- Veterinary Centers of America (VCA) Japan Shiraishi Animal Hospital, Saitama, Japan.,Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Kazumi Shimada
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Lina Hamabe
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Tsuyoshi Uchide
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Katsuhiro Matsuura
- Veterinary Centers of America (VCA) Japan Shiraishi Animal Hospital, Saitama, Japan.,Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Japan
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Fukumitsu M, Westerhof BE, Ruigrok D, Braams NJ, Groeneveldt JA, Bayoumy AA, Marcus JT, Meijboom LJ, de Man FS, Westerhof N, Bogaard HJ, Vonk Noordegraaf A. Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension. Am J Physiol Heart Circ Physiol 2020; 319:H1438-H1450. [PMID: 33035435 DOI: 10.1152/ajpheart.00442.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are as follows: 1) to investigate whether reflected pressure returns sooner in proximal than in distal CTEPH and 2) to elucidate whether the timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy, and wall stress. Right heart catheterization and cardiac MRI were performed in 17 patients with proximal CTEPH and 17 patients with distal CTEPH. In addition to the determination of PVR, compliance, and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as %systole). Findings were related to RV dimensions and time-resolved RV wall stress. Proximal CTEPH was characterized by higher RV volumes, mass, and wall stress, and lower RVEF. While PVR, compliance, and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53 ± 8% vs. distal 63 ± 15%, P < 0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass, and wall stress were all related to the timing of peak reflected pressure. Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance, and characteristic impedance do not explain the differences in RV function between proximal and distal CTEPH.NEW & NOTEWORTHY In chronic thromboembolic pulmonary hypertension (CTEPH), proximal localization of vessel obstructions is associated with poor right ventricular (RV) function compared with distal localization, though pulmonary vascular resistance, vascular compliance, characteristic impedance, and the magnitude of wave reflection are similar. In proximal CTEPH, the RV is exposed to an earlier return of the reflected wave. Early wave reflection may increase RV wall stress and compromise RV function.
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Affiliation(s)
- Masafumi Fukumitsu
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Dieuwertje Ruigrok
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Joanne A Groeneveldt
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmed A Bayoumy
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine, Chest Unit, Suez Canal University Hospitals, Suez Canal University, Ismailia, Egypt
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Nico Westerhof
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Uemura K, Nishikawa T, Kawada T, Sugimachi M. Comprehensive analysis of effective reflection distance and its association with wave reflection strength under diverse hemodynamic conditions in anesthetized dogs. J Biomech 2020; 104:109753. [PMID: 32209244 DOI: 10.1016/j.jbiomech.2020.109753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Abstract
Pressure wave reflection is associated with cardiovascular risk. The conceptual distance to a theoretical major reflection site, termed effective reflection distance (ERD), has been associated with aging and augmentation index (AIx) clinically. However, it remains unclear whether and how ERD varies and associates with AIx when the hemodynamic condition is acutely perturbed in a patient. The objective of this study was to address this issue in rigorously controlled animal experiments. In 13 anesthetized dogs, we measured arterial pressure, aortic flow and femoral arterial flow, while altering the hemodynamic condition over wide ranges by administering zatebradine (bradycardic agent), nitroprusside (vasodilator), noradrenaline (vasoconstrictor), dobutamine (inotrope), and dextran (volume-expander). Using the measured data, we determined ERD based on an arterial model comprising a tube with a complex frequency-dependent load (ERDTL), which has been considered a physiologically valid model. We also determined ERD based on wave separation (ERDWSA) and pressure-based analyses (ERDAW). ERDTL was shortened significantly in response to nitroprusside or dobutamine infusion, and was significantly and negatively associated with AIx in multiple regression analysis using pooled data. ERDWSA or ERDAW did not necessarily correlate with ERDTL in terms of responses to drug administration or association with AIx. In conclusion, under diverse hemodynamic conditions, ERDTL changes sensitively and shows physiologically reasonable association with AIx. This result substantiates the importance of paying close attention to medications during clinical analysis of wave reflection. Caution is required when using ERDWSA or ERDAW as an alternative to ERDTL.
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Affiliation(s)
- Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan.
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
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Fukumitsu M, Kawada T, Shimizu S, Sugimachi M. The pulsatile component of left atrial pressure has little effect on pulmonary artery impedance estimation in normal rats. Physiol Rep 2018; 6:e13946. [PMID: 30556341 PMCID: PMC6295444 DOI: 10.14814/phy2.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 11/24/2022] Open
Abstract
Pulmonary artery impedance (PAZ) that measures the pulsatile properties of the vasculature provides diagnostic and prognostic information in patients with pulmonary vascular diseases. While downstream pressure [i.e., left atrial (LA) pressure] should be considered when calculating static properties of pulmonary vasculature, PAZ is commonly estimated without taking into account the pulsatile component of LA pressure. We examined whether PAZ can be estimated with reasonable accuracy without using LA pressure. Pulmonary artery (PA) flow, PA pressure, and LA pressure were measured under irregular pacing in eight normal Sprague-Dawley rats. PAZ was estimated by analyzing a one-input, one-output system (I1O1 analysis) that does not include LA pressure, and a two-input, one-output system (I2O1 analysis) that includes LA pressure. Using a tube and 3-element Windkessel model, PAZ was parameterized as peripheral resistance (RP ), arterial compliance (CP ), characteristic impedance (ZC ), and transmission time to the reflection site (TD ). These parameters were not significantly different between the I1O1 and I2O1 analyses (RP : 0.286 ± 0.040 vs. 0.274 ± 0.038 mmHg·min/mL, CP : 0.352 ± 0.049 vs. 0.343 ± 0.041 mL/mmHg, ZC : 0.115 ± 0.005 vs. 0.117 ± 0.005 mmHg·min/mL, TD : 13.2 ± 1.8 vs. 12.9 ± 1.7 msec). In conclusion, the I1O1 analysis that does not use LA pressure estimates PAZ with reasonable accuracy compared with the I2O1 analysis that uses LA pressure in normal rats. Our finding that the pulsatile component of LA pressure contributes little to PAZ estimation may justify the clinical use of the I1O1 analysis.
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Affiliation(s)
- Masafumi Fukumitsu
- Department of Cardiovascular DynamicsNational Cerebral and Cardiovascular CenterOsakaJapan
- William Harvey Research InstituteBarts and The London School of MedicineQueen Mary University of LondonLondonUnited Kingdom
| | - Toru Kawada
- Department of Cardiovascular DynamicsNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Shuji Shimizu
- Department of Cardiovascular DynamicsNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Masaru Sugimachi
- Department of Cardiovascular DynamicsNational Cerebral and Cardiovascular CenterOsakaJapan
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