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Ahmad A, Zou Y, Zhang P, Li L, Wang X, Wang Y, Fan F. Non-invasive imaging techniques for early diagnosis of bilateral cardiac dysfunction in pulmonary hypertension: current crests, future peaks. Front Cardiovasc Med 2024; 11:1393580. [PMID: 38784167 PMCID: PMC11112117 DOI: 10.3389/fcvm.2024.1393580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/05/2024] [Indexed: 05/25/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic and progressive disease that eventually leads to heart failure (HF) and subsequent fatality if left untreated. Right ventricular (RV) function has proven prognostic values in patients with a variety of heart diseases including PAH. PAH is predominantly a right heart disease; however, given the nature of the continuous circulatory system and the presence of shared septum and pericardial constraints, the interdependence of the right and left ventricles is a factor that requires consideration. Accurate and timely assessment of ventricular function is very important in the management of patients with PAH for disease outcomes and prognosis. Non-invasive modalities such as cardiac magnetic resonance (CMR) and echocardiography (two-dimensional and three-dimensional), and nuclear medicine, positron emission tomography (PET) play a crucial role in the assessment of ventricular function and disease prognosis. Each modality has its own strengths and limitations, hence this review article sheds light on (i) ventricular dysfunction in patients with PAH and RV-LV interdependence in such patients, (ii) the strengths and limitations of all available modalities and parameters for the early assessment of ventricular function, as well as their prognostic value, and (iii) lastly, the challenges faced and the potential future advancement in these modalities for accurate and early diagnosis of ventricular function in PAH.
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Affiliation(s)
- Ashfaq Ahmad
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yifan Zou
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lingling Li
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoyu Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yousen Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fenling Fan
- Department of Cardiovascular Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Lim P, Delmas C, Sanchez O, Meneveau N, Rosario R, Bouvaist H, Bernard A, Mansourati J, Couturaud F, Sebbane M, Coste P, Rohel G, Tardy B, Biendel C, Lairez O, Ivanes F, Gallet R, Dubois-Rande JL, Fard D, Chatelier G, Simon T, Paul M, Natella PA, Layese R, Bastuji-Garin S. Diuretic vs. placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 11:2-9. [PMID: 34632490 DOI: 10.1093/ehjacc/zuab082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/01/2021] [Indexed: 11/12/2022]
Abstract
AIMS The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo. METHODS AND RESULTS Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04-1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (-2; 14) vs. -1 µM/L (-11; 6), P < 0.001]. CONCLUSION In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation.ClinicalTrials.gov identifier NCT02268903.
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Affiliation(s)
- Pascal Lim
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | | | - Olivier Sanchez
- Université de Paris, Paris, France.,Division of Respiratory and Intensive Care, AP-HP, Hôpital Europèen Georges Pompidou, Paris, France.,INSERM UMR-S 1140, Innovative Therapies in Haemostasis, Paris, France
| | - Nicolas Meneveau
- Cardiology Department, Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Roger Rosario
- Cardiology Department, Hôpital Saint-Joseph, Marseille, France
| | | | - Anne Bernard
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Jacques Mansourati
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | - Francis Couturaud
- Respiratory Department, CHRU de la Cavale Blanche, Brest, France and University Hospital of Brest and UBO (Université de Bretagne Occidentale)
| | | | - Pierre Coste
- Cardiology Department, Bordeaux University Hospital, France
| | - Gwenole Rohel
- Cardiology Department, Military Hospital of Clermont Tonnerre, Brest, France
| | - Bernard Tardy
- Emergency Department, CHU Saint Etienne, Saint Pirest en Jarez, France
| | | | | | - Fabrice Ivanes
- Cardiology Department, CHU, Tours, France and EA4245, Université de Tours, France
| | - Romain Gallet
- Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France.,Emergency Department, CHRU Lapeyronie, Montpellier, France
| | - Jean-Luc Dubois-Rande
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Damien Fard
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Cardiology, AP-HP Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Gilles Chatelier
- Clinical Research Department, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Tabassome Simon
- Cinical Pharmacology, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Muriel Paul
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,AP-HP Hôpitaux Universitaires Henri-Mondor, Clinical Pharmacology, Créteil F-94010, France
| | - Pierre-André Natella
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
| | - Richard Layese
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France
| | - Sylvie Bastuji-Garin
- Université Paris Est Creteil, INSERM, IMRB, Creteil F-94010, France.,Department of Public Health, AP-HP Hôpitaux Universitaires Henri-Mondor, Creteil F-94010, France
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3
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Sonaglioni A, Caminati A, Lipsi R, Nicolosi GL, Lombardo M, Anzà C, Harari S. Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure. Int J Cardiovasc Imaging 2020; 36:1711-1723. [PMID: 32448985 DOI: 10.1007/s10554-020-01887-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case-control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e' ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (- 22.6 ± 3.3% vs - 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = - 0.87 and - 0.82, respectively) but not in controls (r = - 0.29 and - 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Antonella Caminati
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy.
| | - Roberto Lipsi
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
| | - Gian Luigi Nicolosi
- Department of Cardiology, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy
| | - Sergio Harari
- Semi-Intensive Care Unit, Department of Pneumology, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy
- Department of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Impaired Right and Left Ventricular Longitudinal Function in Patients with Fibrotic Interstitial Lung Diseases. J Clin Med 2020; 9:jcm9020587. [PMID: 32098133 PMCID: PMC7073641 DOI: 10.3390/jcm9020587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Left ventricular (LV) and right ventricular (RV) dysfunction is recognized in idiopathic pulmonary fibrosis (IPF). Little is known about cardiac involvement in non-idiopathic pulmonary fibrosis (no-IPF). This issue can be explored by advanced echocardiography. Methods: Thirty-three clinically stable and therapy-naive fibrotic IPF and 28 no-IPF patients, and 30 healthy controls were enrolled. Exclusion criteria were autoimmune systemic diseases, coronary disease, heart failure, primary cardiomyopathies, chronic obstructive lung diseases, pulmonary embolism, primary pulmonary hypertension. Lung damage was evaluated by diffusion capacity for carbon monoxide (DLCOsb). All participants underwent an echo-Doppler exam including 2D global longitudinal strain (GLS) of both ventricles and 3D echocardiographic RV ejection fraction (RVEF). Results: We observed LV diastolic dysfunction in IPF and no-IPF, and LV GLS but not LV EF reduction only in IPF. RV diastolic and RV GLS abnormalities were observed in IPF versus both controls and no-IPF. RV EF did not differ significantly between IPF and no-IPF. DLCOsb and RV GLS were associated in the pooled pulmonary fibrosis population and in the IPF subgroup (β = 0.708, p < 0.001), independently of confounders including pulmonary arterial systolic pressure. Conclusion: Our data highlight the unique diagnostic capabilities of GLS in distinguishing early cardiac damage of IPF from no-IPF patients.
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Sareban M, Perz T, Macholz F, Reich B, Schmidt P, Fried S, Mairbäurl H, Berger MM, Niebauer J. Impairment of left atrial mechanics does not contribute to the reduction in stroke volume after active ascent to 4559 m. Scand J Med Sci Sports 2018; 29:223-231. [PMID: 30372563 PMCID: PMC7379646 DOI: 10.1111/sms.13325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 01/07/2023]
Abstract
Hypoxia challenges left ventricular (LV) function due to reduced energy supply. Conflicting results exist whether high‐altitude exposure impairs LV diastolic function and thus contributes to the high altitude‐induced increase in systolic pulmonary artery pressure (sPAP) and reduction in stroke volume (SV). This study aimed to assess LV diastolic function, LV end‐diastolic pressure (LVEDP), and LA mechanics using comprehensive echocardiographic imaging in healthy volunteers at 4559 m. Fifty subjects performed rapid (<20 hours) and active ascent from 1130 m to 4559 m (high). All participants underwent echocardiography during baseline examination at 424 m (low) as well as 7, 20 and 44 hours after arrival at high altitude. Heart rate (HR), sPAP, and comprehensive volumetric‐ and Doppler‐ as well as speckle tracking‐derived LA strain parameters were obtained to assess LV diastolic function, LA mechanics, and LVEDP in a multiparametric approach. Data for final analyses were available in 46 subjects. HR (low: 64 ± 11 vs high: 79 ± 14 beats/min, P < 0.001) and sPAP (low: 24.4 ± 3.8 vs high: 38.5 ± 8.2 mm Hg, P < 0.001) increased following ascent and remained elevated at high altitude. Stroke volume (low: 64.5 ± 15.0 vs high: 58.1 ± 16.4 mL, P < 0.001) and EDV decreased following ascent and remained decreased at high altitude due to decreased LV passive filling volume, whereas LA mechanics were preserved. There was no case of LV diastolic dysfunction or increased LVEDP estimates. In summary, this study shows that rapid and active ascent of healthy individuals to 4559 m impairs passive filling and SV of the LV. These alterations were not related to changes in LV and LA mechanics.
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Affiliation(s)
- Mahdi Sareban
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Tabea Perz
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Franziska Macholz
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Reich
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Peter Schmidt
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Sebastian Fried
- Medical Clinic VII, Sports Medicine, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Heimo Mairbäurl
- Medical Clinic VII, Sports Medicine, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Marc M Berger
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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Palau-Caballero G, Walmsley J, Van Empel V, Lumens J, Delhaas T. Why septal motion is a marker of right ventricular failure in pulmonary arterial hypertension: mechanistic analysis using a computer model. Am J Physiol Heart Circ Physiol 2016; 312:H691-H700. [PMID: 28039201 DOI: 10.1152/ajpheart.00596.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/22/2022]
Abstract
Rapid leftward septal motion (RLSM) during early left ventricular (LV) diastole is observed in patients with pulmonary arterial hypertension (PAH). RLSM exacerbates right ventricular (RV) systolic dysfunction and impairs LV filling. Increased RV wall tension caused by increased RV afterload has been suggested to cause interventricular relaxation dyssynchrony and RLSM in PAH. Simulations using the CircAdapt computational model were used to unravel the mechanism underlying RLSM by mechanistically linking myocardial tissue and pump function. Simulations of healthy circulation and mild, moderate, and severe PAH were performed. We also assessed the effects on RLSM when PAH coexists with RV or LV contractile dysfunction. Our results showed prolonged RV shortening in PAH causing interventricular relaxation dyssynchrony and RLSM. RLSM was observed in both moderate and severe PAH. A negative transseptal pressure gradient only occurred in severe PAH, demonstrating that negative pressure gradient does not entirely explain septal motion abnormalities. PAH coexisting with RV contractile dysfunction exacerbated both interventricular relaxation dyssynchrony and RLSM. LV contractile dysfunction reduced both interventricular relaxation dyssynchrony and RLSM. In conclusion, dyssynchrony in ventricular relaxation causes RLSM in PAH. Onset of RLSM in patients with PAH appears to indicate a worsening in RV function and hence can be used as a sign of RV failure. However, altered RLSM does not necessarily imply an altered RV afterload, but it can also indicate altered interplay of RV and LV contractile function. Reduction of RLSM can result from either improved RV function or a deterioration of LV function.NEW & NOTEWORTHY A novel approach describes the mechanism underlying abnormal septal dynamics in pulmonary arterial hypertension. Change in motion is not uniquely induced by altered right ventricular afterload, but also by altered ventricular relaxation dyssynchrony. Extension or change in motion is a marker reflecting interplay between right and left ventricular contractility.
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Affiliation(s)
- Georgina Palau-Caballero
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - John Walmsley
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - Vanessa Van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
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Hebisz P, Hebisz R, Zatoń M, Ochmann B, Mielnik N. Concomitant application of sprint and high-intensity interval training on maximal oxygen uptake and work output in well-trained cyclists. Eur J Appl Physiol 2016; 116:1495-502. [PMID: 27262887 DOI: 10.1007/s00421-016-3405-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/28/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE In this study, we compared the effects of two different training modalities on maximal oxygen uptake and work output. METHODS Participants included 26 well-trained mountain bike cyclists were divided into two groups. The first group trained using a conventional endurance protocol at steady-state (moderate) intensity and variable-intensity (high-moderate-low) free of maximal efforts. The second group combined endurance training with a sprint and high-intensity interval training protocol, which, respectively, were based on 30 s maximal repetitions and 4 min high intensity repetitions. Training duration was 8 weeks. A graded exercise test was administered pre- and post-training. Work output, oxygen uptake, minute pulmonary ventilation, heart rate and stroke volume were determined during the test. RESULTS While work output significantly increased post-training in both groups (P < 0.05), the interval training group showed a greater magnitude of change (from 284.4 ± 91.9 to 314.2 ± 95.1 kJ) than the endurance training group (from 271.8 ± 73.3 to 283.4 ± 72.3 kJ). Significant increases in maximal oxygen uptake (from 57.9 ± 6.8 to 66.6 ± 5.3 ml kg(-1) min(-1)), maximal pulmonary ventilation and stroke volume were observed only in the interval training group. CONCLUSIONS An exercise protocol involving endurance and sprint and high-intensity interval training was found to induce positive effects on maximal oxygen uptake in a group of well-trained cyclists with several years athletic experience.
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Affiliation(s)
- Paulina Hebisz
- Department of Physiology and Biochemistry, University School of Physical Education in Wroclaw, 35 J.I. Paderewski Avenue, 51-612, Wroclaw, Poland.
| | - Rafał Hebisz
- Department of Physiology and Biochemistry, University School of Physical Education in Wroclaw, 35 J.I. Paderewski Avenue, 51-612, Wroclaw, Poland.,National Team Coach, Polish Cycling Federation, Pruszków, Poland
| | - Marek Zatoń
- Department of Physiology and Biochemistry, University School of Physical Education in Wroclaw, 35 J.I. Paderewski Avenue, 51-612, Wroclaw, Poland
| | - Bartosz Ochmann
- Department of Physiology and Biochemistry, University School of Physical Education in Wroclaw, 35 J.I. Paderewski Avenue, 51-612, Wroclaw, Poland
| | - Natalia Mielnik
- Department of Physiology and Biochemistry, University School of Physical Education in Wroclaw, 35 J.I. Paderewski Avenue, 51-612, Wroclaw, Poland
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8
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Crnkovic S, Schmidt A, Egemnazarov B, Wilhelm J, Marsh LM, Ghanim B, Klepetko W, Olschewski A, Olschewski H, Kwapiszewska G. Functional and molecular factors associated with TAPSE in hypoxic pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2016; 311:L59-73. [PMID: 27106290 DOI: 10.1152/ajplung.00381.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/17/2016] [Indexed: 01/11/2023] Open
Abstract
Adaptation of the right ventricle (RV) to increased afterload is crucial for survival in pulmonary hypertension (PH), but it is challenging to assess RV function and identify associated molecular mechanisms. The aim of the current study was to analyze the relationship between invasive and noninvasive parameters of RV morphology and function and associated molecular changes. The response of mice to normobaric hypoxia was assessed by hechocardiography, invasive hemodynamics, and histological and molecular analyses. Plasma levels of possibly novel markers of RV remodeling were measured by ELISA in patients with idiopathic pulmonary arterial hypertension (IPAH) and matched healthy controls. Chronic hypoxia-induced PH was accompanied by significantly decreased tricuspid annular plane systolic excursion (TAPSE) and unchanged RV contractility index and tau. RV hypertrophy was present without an increase in fibrosis. There was no change in α- and β-major histocompatibility class or natriuretic peptides expression. Comparative microarray analysis identified two soluble factors, fibroblast growth factor-5 (FGF5) and interleukin-22 receptor alpha-2 (IL22RA2), as being possibly associated with RV remodeling. We observed significantly higher plasma levels of IL22RA2, but not FGF5, in patients with IPAH. Hypoxic pulmonary hypertension in a stage of RV remodeling with preserved systolic function is associated with decreased pulmonary vascular compliance, mild diastolic RV dysfunction, and significant decrease in TAPSE. Subtle gene expression changes in the RV vs. the left ventricle upon chronic hypoxia suggest that the majority of changes are due to hypoxia and not due to changes in afterload. Increased IL22RA2 levels might represent a novel RV adaptive mechanism.
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Affiliation(s)
- Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Experimental Anaesthesiology, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Jochen Wilhelm
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bahil Ghanim
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Thoracic Surgery, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna/Vienna General Hospital, Vienna, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Experimental Anaesthesiology, Medical University of Graz, Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; and
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Department of Experimental Anaesthesiology, Medical University of Graz, Graz, Austria
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9
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Secchi F, Petrini M, Di Leo G, Bandera F, Castelvecchio S, Guazzi M, Menicanti L, Sardanelli F. Recoupling of right and left ventricle pump function after surgical ventricle restoration: a cardiac magnetic resonance study. Int J Cardiovasc Imaging 2015; 31:813-20. [DOI: 10.1007/s10554-015-0599-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/20/2015] [Indexed: 11/24/2022]
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10
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Reichenbach A, Al-Hiti H, Malek I, Pirk J, Goncalvesova E, Kautzner J, Melenovsky V. The effects of phosphodiesterase 5 inhibition on hemodynamics, functional status and survival in advanced heart failure and pulmonary hypertension: A case–control study. Int J Cardiol 2013; 168:60-5. [DOI: 10.1016/j.ijcard.2012.09.074] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/25/2012] [Accepted: 09/14/2012] [Indexed: 11/15/2022]
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11
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Bshouty Z. Vascular compromise and hemodynamics in pulmonary arterial hypertension: model predictions. Can Respir J 2012; 19:209-15. [PMID: 22679614 PMCID: PMC3418096 DOI: 10.1155/2012/764545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A previously validated computer model of the normal pulmonary circulation is adapted to simulate pulmonary arterial hypertension (PAH) in humans. Model predictions are used to explore the suitability of currently accepted criteria for diagnosing PAH by correlating hemodynamic data with the degree of vascular compromise (disease severity). Model predictions demonstrate a hyperbolic relationship between vascular compromise, mean pulmonary artery pressure (PAPm) and pulmonary vascular resistance (PVR). PAPm and PVR change very little from disease initiation until a vascular compromise of 65% to 70% (surface area of 0.35 to 0.3 of baseline, respectively) is reached. Following that, further compromise is associated with a steep rise in PAPm and PVR. The relationship between vascular compromise and hemodynamics may explain the relative stability of cardiac output early in this disease process and, therefore, the lack of symptoms. It also explains the rapid deterioration following diagnosis if the disease remains untreated. Model predictions demonstrate the inadequacy of the current hemodynamic criteria for diagnosing PAH over a wide range of left atrial pressure and cardiac output combinations and for early detection of disease. The model provides an alternative approach to diagnosing PAH by translating hemodynamic data to degree of vascular compromise.
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Affiliation(s)
- Zoheir Bshouty
- Section of Respiratory Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3A 1R8, Canada.
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Leenders GE, Lumens J, Cramer MJ, De Boeck BW, Doevendans PA, Delhaas T, Prinzen FW. Septal Deformation Patterns Delineate Mechanical Dyssynchrony and Regional Differences in Contractility. Circ Heart Fail 2012; 5:87-96. [DOI: 10.1161/circheartfailure.111.962704] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Response to cardiac resynchronization therapy depends both on dyssynchrony and (regional) contractility. We hypothesized that septal deformation can be used to infer integrated information on dyssynchrony and regional contractility, and thereby predict cardiac resynchronization therapy response.
Methods and Results—
In 132 cardiac resynchronization therapy candidates with left bundle branch block (LBBB)-like electrocardiogram morphology (left ventricular ejection fraction 19±6%; QRS width 170±23 ms), longitudinal septal strain was assessed by speckle tracking echocardiography. To investigate the effects of dyssynchronous activation and differences in septal and left ventricular free wall contractility on septal deformation pattern, we used the CircAdapt computer model of the human heart and circulation. In the patients, 3 characteristic septal deformation patterns were identified: LBBB-1=double-peaked systolic shortening (n=28); LBBB-2=early systolic shortening followed by prominent systolic stretching (n=34); and LBBB-3=pseudonormal shortening with less pronounced late systolic stretch (n=70). LBBB-3 revealed more scar (2 [2–5] segments) compared with LBBB-1 and LBBB-2 (both 0 [0–1],
P
<0.05). In the model, imposing a time difference of activation between septum and left ventricular free wall resulted in pattern LBBB-1. This transformed into pattern LBBB-2 by additionally simulating septal hypocontractility, and into pattern LBBB-3 by imposing additional left ventricular free wall or global left ventricular hypocontractility. Improvement of left ventricular ejection fraction and reduction of left ventricular volumes after cardiac resynchronization therapy were most pronounced in LBBB-1 and worst in LBBB-3 patients.
Conclusions—
A double-peaked systolic septal deformation pattern is characteristic for LBBB and results from intraventricular dyssynchrony. Abnormal contractility modifies this pattern. A computer model can be helpful in understanding septal deformation and predicting cardiac resynchronization therapy response.
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Affiliation(s)
- Geert E. Leenders
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Joost Lumens
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Maarten J. Cramer
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Bart W.L. De Boeck
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Pieter A. Doevendans
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Tammo Delhaas
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
| | - Frits W. Prinzen
- From the Department of Cardiology, University Medical Center Utrecht (G.E.L., M.J.C., P.A.D.), Utrecht, the Netherlands; Departments of Physiology and Biomedical Engineering, Cardiovascular Research Institute Maastricht (J.L., T.D., F.W.P.), Maastricht, the Netherlands; Kantonsspital Luzern (B.W.L.D.B.), Luzern, Switzerland
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Matsumoto T, Ando N, Tomii T, Uesugi K. Three-dimensional cortical bone microstructure in a rat model of hypoxia-induced growth retardation. Calcif Tissue Int 2011; 88:54-62. [PMID: 20848090 DOI: 10.1007/s00223-010-9415-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022]
Abstract
Little is known about hypoxia-induced modification of the canal network in the cortical bone despite its involvement in intracortical vascularity and bone blood supply. In this study, we examined the effect of chronic hypoxia on the canal network in postnatal bone. Tibiae were harvested from 4- and 8-week-old rats (hyp-4 and -8, n = 8 each), whose growth was retarded owing to postnatal exposure to hypoxia (12-14% O₂), and from 3- and 4-week-old normoxic rats (cnt-4 and -5, n = 8 each), which were similar in tibial length and cortical cross-sectional area to hyp-4 and -8, respectively. The diaphyseal canals were detected by monochromatic synchrotron radiation CT with a 3.1-μm voxel resolution. The anatomical properties of the canal network were compared between age- or size-matched hypoxic and normoxic groups. The canals were larger in diameter, were more densely distributed and connected, and opened into the marrow cavity with a higher density in hyp-4 than in cnt-4. The canal density and connectivity were also higher in hyp-4 than in cnt-3. The canal diameter, density, and connectivity were smaller in hyp-8 than in cnt-4; however, the densities of endocortical and periosteal canal openings did not differ between hyp-8 and cnt-4. We concluded that chronic hypoxia enhanced the formation of cortical canal networks at the postnatal developmental stage, probably facilitating intra- and transcortical vascularization and bone perfusion accordingly.
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Affiliation(s)
- Takeshi Matsumoto
- Bioengineering Division, Osaka University Graduate School of Engineering Science, Machikaneyama-cho 1-3, Toyonaka 560-8531, Japan.
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14
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Calmettes G, Deschodt-Arsac V, Gouspillou G, Miraux S, Muller B, Franconi JM, Thiaudiere E, Diolez P. Improved energy supply regulation in chronic hypoxic mouse counteracts hypoxia-induced altered cardiac energetics. PLoS One 2010; 5:e9306. [PMID: 20174637 PMCID: PMC2823784 DOI: 10.1371/journal.pone.0009306] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 01/30/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypoxic states of the cardiovacular system are undoubtedly associated with the most frequent diseases of modern time. Therefore, understanding hypoxic resistance encountered after physiological adaptation such as chronic hypoxia, is crucial to better deal with hypoxic insult. In this study, we examine the role of energetic modifications induced by chronic hypoxia (CH) in the higher tolerance to oxygen deprivation. METHODOLOGY/PRINCIPAL FINDINGS Swiss mice were exposed to a simulated altitude of 5500 m in a barochamber for 21 days. Isolated perfused hearts were used to study the effects of a decreased oxygen concentration in the perfusate on contractile performance (RPP) and phosphocreatine (PCr) concentration (assessed by (31)P-NMR), and to describe the integrated changes in cardiac energetics regulation by using Modular Control Analysis (MoCA). Oxygen reduction induced a concomitant decrease in RPP (-46%) and in [PCr] (-23%) in Control hearts while CH hearts energetics was unchanged. MoCA demonstrated that this adaptation to hypoxia is the direct consequence of the higher responsiveness (elasticity) of ATP production of CH hearts compared with Controls (-1.88+/-0.38 vs -0.89+/-0.41, p<0.01) measured under low oxygen perfusion. This higher elasticity induces an improved response of energy supply to cellular energy demand. The result is the conservation of a healthy control pattern of contraction in CH hearts, whereas Control hearts are severely controlled by energy supply. CONCLUSIONS/SIGNIFICANCE As suggested by the present study, the mechanisms responsible for this increase in elasticity and the consequent improved ability of CH heart metabolism to respond to oxygen deprivation could participate to limit the damages induced by hypoxia.
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Affiliation(s)
- Guillaume Calmettes
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Véronique Deschodt-Arsac
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Gilles Gouspillou
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Sylvain Miraux
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Bernard Muller
- Laboratoire de Pharmacologie, INSERM U885, Université Bordeaux 2, Bordeaux, France
| | - Jean-Michel Franconi
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Eric Thiaudiere
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
| | - Philippe Diolez
- Laboratoire de Résonance Magnétique des Systèmes Biologiques, UMR 5536 CNRS Université Bordeaux 2, Bordeaux, France
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15
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Miura T. Epicardium and pericardium: a joint force for infarct repair? J Mol Cell Cardiol 2010; 48:579-81. [PMID: 20096287 DOI: 10.1016/j.yjmcc.2010.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 12/22/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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16
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Melenovsky V, Al-Hiti H, Kazdova L, Jabor A, Syrovatka P, Malek I, Kettner J, Kautzner J. Transpulmonary B-type natriuretic peptide uptake and cyclic guanosine monophosphate release in heart failure and pulmonary hypertension: the effects of sildenafil. J Am Coll Cardiol 2009; 54:595-600. [PMID: 19660688 DOI: 10.1016/j.jacc.2009.05.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/30/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to identify factors that discriminate heart failure (HF) patients with normal and elevated pulmonary vascular resistance (PVR) and to elucidate the role of cyclic guanosine monophosphate (cGMP)-dependent vasodilation. BACKGROUND Mechanisms of PVR increase in patients with chronic HF are incompletely understood. METHODS Twenty-two HF patients with high pulmonary vascular resistance (H-PVR) (>200 dyn.s.cm(-5)) were compared with 24 matched low pulmonary vascular resistance (L-PVR) patients of similar age, sex, body size, HF severity, and volume status who were undergoing invasive hemodynamic study. Pulmonary arterial (PA) and venous blood samples from a wedged PA catheter were used to calculate transpulmonary B-type natriuretic peptide (BNP) uptake and cGMP release. The H-PVR patients were re-examined 1 h after a 40-mg oral dose of sildenafil. RESULTS Although transpulmonary BNP uptake was similar (p = 0.2), cGMP release was diminished in the H-PVR patients (-1.9 vs. 27.8 nmol.min(-1); p = 0.005). Transpulmonary BNP uptake and cGMP release correlated in the L-PVR patients (R = 0.6, p = 0.004) but not in the H-PVR. The H-PVR patients also had lower PA compliance, systemic arterial compliance (by 47% and 20%, p < 0.001 and p < 0.03), and cardiac index. Sildenafil reduced PVR (-47%), systemic resistance (-24%) and heart rate (-8%), increased cardiac index (+24%), and PA compliance (+87%, all p < 0.001), with a parallel increase of cGMP release (from -5.6 to 16.5 nmol.min(-1), p = 0.047), without affecting BNP uptake or norepinephrine(PA). The PVR response was not dependent on PA wedge pressure or pulmonary hypertension reversibility with prostaglandin E(1). CONCLUSIONS The H-PVR patients have stiffening of both pulmonary and systemic arteries, preserved transpulmonary BNP uptake, but diminished cGMP release, which is reversible by the administration of sildenafil. This study provides in vivo evidence that phosphodiesterase 5A inhibition restores sensitivity of pulmonary vasculature to endogenous cGMP-dependent vasodilators.
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Affiliation(s)
- Vojtech Melenovsky
- Department of Cardiology, Institute of Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
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17
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Lumens J, Delhaas T, Kirn B, Arts T. Three-wall segment (TriSeg) model describing mechanics and hemodynamics of ventricular interaction. Ann Biomed Eng 2009; 37:2234-55. [PMID: 19718527 PMCID: PMC2758607 DOI: 10.1007/s10439-009-9774-2] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 07/30/2009] [Indexed: 11/28/2022]
Abstract
A mathematical model (TriSeg model) of ventricular mechanics incorporating mechanical interaction of the left and right ventricular free walls and the interventricular septum is presented. Global left and right ventricular pump mechanics were related to representative myofiber mechanics in the three ventricular walls, satisfying the principle of conservation of energy. The walls were mechanically coupled satisfying tensile force equilibrium in the junction. Wall sizes and masses were rendered by adaptation to normalize mechanical myofiber load to physiological standard levels. The TriSeg model was implemented in the previously published lumped closed-loop CircAdapt model of heart and circulation. Simulation results of cardiac mechanics and hemodynamics during normal ventricular loading, acute pulmonary hypertension, and chronic pulmonary hypertension (including load adaptation) agreed with clinical data as obtained in healthy volunteers and pulmonary hypertension patients. In chronic pulmonary hypertension, the model predicted right ventricular free wall hypertrophy, increased systolic pulmonary flow acceleration, and increased right ventricular isovolumic contraction and relaxation times. Furthermore, septal curvature decreased linearly with its transmural pressure difference. In conclusion, the TriSeg model enables realistic simulation of ventricular mechanics including interaction between left and right ventricular pump mechanics, dynamics of septal geometry, and myofiber mechanics in the three ventricular walls.
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Affiliation(s)
- Joost Lumens
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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18
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Borbély A, Papp Z, Edes I, Paulus WJ. Molecular determinants of heart failure with normal left ventricular ejection fraction. Pharmacol Rep 2009; 61:139-45. [PMID: 19307702 DOI: 10.1016/s1734-1140(09)70016-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/15/2009] [Indexed: 10/25/2022]
Abstract
In population-based studies, heart failure with normal left ventricular (LV) ejection fraction (HFNEF) is now increasingly recognized and referred to as diastolic heart failure. However, the pathogenic mechanisms underlying HFNEF are incompletely understood, mainly because of limited availability of human myocardial biopsy material. Nevertheless, recent studies have examined in vivo hemodynamics, in vitro cardiomyocyte function, myofilamentary protein composition, collagen content and deposition of advanced glycation end products from LV endomyocardial biopsies. These measures were compared between HFNEF patients, subjects without symptoms of heart failure (controls), patients with heart failure and reduced ejection function (HFREF), and patients with HFNEF and HFREF with diabetes mellitus. This article summarizes the various findings of these studies and focuses on the possible correlations among altered LV myocardial structure, cardiomyocyte function, myofilamentary proteins, and extracellular matrices. These findings revealed novel mechanisms responsible for diastolic LV dysfunction, and they have important therapeutic implications, particularly HFNEF, for which a specific heart failure treatment strategy is largely lacking.
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Affiliation(s)
- Attila Borbély
- Division of Clinical Physiology, Institute of Cardiology, University of Debrecen, Medical and Health Science Center, Móricz Zsigmond 22, Debrecen, Hungary.
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20
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Bernheim AM, Kiencke S, Fischler M, Dorschner L, Debrunner J, Mairbäurl H, Maggiorini M, Brunner-La Rocca HP. Acute Changes in Pulmonary Artery Pressures Due to Exercise and Exposure to High Altitude Do Not Cause Left Ventricular Diastolic Dysfunction. Chest 2007; 132:380-7. [PMID: 17573520 DOI: 10.1378/chest.07-0297] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Altitude-induced pulmonary hypertension has been suggested to cause left ventricular (LV) diastolic dysfunction due to ventricular interaction. In this study, we evaluate the effects of exercise- and altitude-induced increase in pulmonary artery pressures on LV diastolic function in an interventional setting investigating high-altitude pulmonary edema (HAPE) prophylaxis. METHODS Among 39 subjects, 29 were HAPE susceptible (HAPE-S) and 10 served as control subjects. HAPE-S subjects were randomly assigned to prophylactic tadalafil (10 mg), dexamethasone (8 mg), or placebo bid, starting 1 day before ascent. Doppler echocardiography at rest and during submaximal exercise was performed at low altitude (490 m) and high altitude (4,559 m). The ratio of early transmitral inflow peak velocity (E) to atrial transmitral inflow peak velocity (A), pulmonary venous flow parameters, and tissue velocity within the septal mitral annulus during early diastole (E') were used to assess LV diastolic properties. LV filling pressures were estimated by E/E'. Systolic right ventricular to atrial pressure gradients (RVPGs) were measured in order to estimate pulmonary artery pressures. RESULTS At 490 m, E/A decreased similarly with exercise in HAPE-S and control subjects (HAPE-S, 1.5 +/- 0.3 to 1.3 +/- 0.3; control, 1.7 +/- 0.4 to 1.3 +/- 0.3; p = 0.12 between groups) [mean +/- SD], whereas RVPG increased significantly more in HAPE-S subjects (20 +/- 5 to 43 +/- 9 mm Hg vs 18 +/- 3 to 28 +/- 3 mm Hg, p < 0.001). Changes in RVPG levels during exercise did not correlate with changes in E/A (p > 0.1). From 490 to 4,559 m, no correlations between changes in RVPG and changes in E/A or atrial reversal (both p > 0.1) were observed. Neither of the groups showed an increase in E/E' from 490 to 4,559 m. CONCLUSION Increased pulmonary artery pressure associated with exercise and acute exposure to 4,559 m appears not to cause LV diastolic dysfunction in healthy subjects. Therefore, ventricular interaction seems not to be of hemodynamic relevance in this setting.
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Affiliation(s)
- Alain M Bernheim
- Division of Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland.
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21
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Cecconi M, Johnston E, Rhodes A. What role does the right side of the heart play in circulation? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10 Suppl 3:S5. [PMID: 17164017 PMCID: PMC3226127 DOI: 10.1186/cc4832] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Right ventricular failure (RVF) is an underestimated problem in intensive care. This review explores the physiology and pathophysiology of right ventricular function and the pulmonary circulation. When RVF is secondary to an acute increase in afterload, the picture is one of acute cor pulmonale, as occurs in the context of acute respiratory distress syndrome, pulmonary embolism and sepsis. RVF can also be caused by right myocardial dysfunction. Pulmonary arterial catheterization and echocardiography are discussed in terms of their roles in diagnosis and treatment. Treatments include options to reduce right ventricular afterload, specific pulmonary vasodilators and inotropes.
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Affiliation(s)
- Maurizio Cecconi
- Department of Intensive Care, St. George's Hospital, London, UK
- Scuola di Anestesia e Rianimazione, University of Studies, Udine, Italy
| | - Edward Johnston
- Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Andrew Rhodes
- Department of Intensive Care, St. George's Hospital, London, UK
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Esch BTA, Bredin SSD, Haykowsky MJ, Scott JM, Warburton DER. The potential role of the pericardium on diastolic filling in endurance-trained athletes under conditions of physiological stress. Appl Physiol Nutr Metab 2007; 32:311-7. [PMID: 17486175 DOI: 10.1139/h06-086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this review, we examine the growing body of evidence suggesting that the pericardium plays an important role in modulating cardiac function during conditions of physiological stress. Specifically, we discuss the effects of the pericardium on left ventricular filling and compliance. Furthermore, we reveal that there is increasing evidence to support the contention that the pericardium is capable of adaptation in response to volume loading. We also provide data that suggests endurance-training is a good example of a physiological stressor capable of causing pericardial remodelling. These adaptations appear particularly beneficial during exercise and may explain (in part) the common finding of stroke volume increasing during exercise to a greater extent in endurance-trained athletes. However, this adaptation may also partially explain the increased susceptibility to orthostatic intolerance in endurance athletes.
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Affiliation(s)
- Ben T A Esch
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Rm. 205, Unit II Osborne Centre, Vancouver, BC V6T 1Z3, Canada
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Esch BTA, Scott JM, Haykowsky MJ, McKenzie DC, Warburton DER. Diastolic ventricular interactions in endurance-trained athletes during orthostatic stress. Am J Physiol Heart Circ Physiol 2007; 293:H409-15. [PMID: 17369463 DOI: 10.1152/ajpheart.00928.2006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Enhanced left-ventricular (LV) compliance is a common adaptation to endurance training. This adaptation may have differential effects under conditions of altered venous return. The purpose of this investigation was to assess the effect of cardiac (un)loading on right ventricular (RV) cavity dimensions and LV volumes in endurance-trained athletes and normally active males. Eight endurance-trained (Vo(2max), 65.4 +/- 5.7 ml.kg(-1).min(-1)) and eight normally active (Vo(2max), 45.1 +/- 6.0 ml.kg(-1).min(-1)) males underwent assessments of the following: 1) Vo(2max), 2) orthostatic tolerance, and 3) cardiac responses to lower-body positive (0-60 mmHg) and negative (0 to -80 mmHg) pressures with echocardiography. In response to negative pressures, echocardiographic analysis revealed a similar decrease in RV end-diastolic cavity area in both groups (e.g., at -80 mmHg: normals, 21.4%; athletes, 20.8%) but a greater decrease in LV end-diastolic volume in endurance-trained athletes (e.g., at -80 mmHg: normals, 32.3%; athletes, 44.4%; P < 0.05). Endurance-trained athletes also had significantly greater decreases in LV stroke volume during lower-body negative pressure. During positive pressures, endurance-trained athletes showed larger increases in LV end-diastolic volume (e.g., at +60 mmHg; normals, 14.1%; athletes, 26.8%) and LV stroke volume, despite similar responses in RV end-diastolic cavity area (e.g., at +60 mmHg: normals, 18.2%; athletes, 24.2%; P < 0.05). This investigation revealed that in response to cardiac (un)loading similar changes in RV cavity area occur in endurance-trained and normally active individuals despite a differential response in the left ventricle. These differences may be the result of alterations in RV influence on the left ventricle and/or intrinsic ventricular compliance.
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Affiliation(s)
- Ben T A Esch
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, British Columbia, Canada
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24
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Kerckhoffs RCP, Neal ML, Gu Q, Bassingthwaighte JB, Omens JH, McCulloch AD. Coupling of a 3D finite element model of cardiac ventricular mechanics to lumped systems models of the systemic and pulmonic circulation. Ann Biomed Eng 2006; 35:1-18. [PMID: 17111210 PMCID: PMC2872168 DOI: 10.1007/s10439-006-9212-7] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
In this study we present a novel, robust method to couple finite element (FE) models of cardiac mechanics to systems models of the circulation (CIRC), independent of cardiac phase. For each time step through a cardiac cycle, left and right ventricular pressures were calculated using ventricular compliances from the FE and CIRC models. These pressures served as boundary conditions in the FE and CIRC models. In succeeding steps, pressures were updated to minimize cavity volume error (FE minus CIRC volume) using Newton iterations. Coupling was achieved when a predefined criterion for the volume error was satisfied. Initial conditions for the multi-scale model were obtained by replacing the FE model with a varying elastance model, which takes into account direct ventricular interactions. Applying the coupling, a novel multi-scale model of the canine cardiovascular system was developed. Global hemodynamics and regional mechanics were calculated for multiple beats in two separate simulations with a left ventricular ischemic region and pulmonary artery constriction, respectively. After the interventions, global hemodynamics changed due to direct and indirect ventricular interactions, in agreement with previously published experimental results. The coupling method allows for simulations of multiple cardiac cycles for normal and pathophysiology, encompassing levels from cell to system.
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Affiliation(s)
- Roy C. P. Kerckhoffs
- Department of Bioengineering, The Whitaker Institute for Biomedical Engineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412, USA
| | - Maxwell L. Neal
- Department of Medical Education and Biomedical Informatics, University of Washington, Seattle, WA 98195, USA
| | - Quan Gu
- Department of Structural Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Jeff H. Omens
- Department of Bioengineering, The Whitaker Institute for Biomedical Engineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093-0613J, USA
| | - Andrew D. McCulloch
- Department of Bioengineering, The Whitaker Institute for Biomedical Engineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0412, USA
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De Marco T, McGlothin D. Managing Right Ventricular Failure in PAH: An Algorithmic Approach. ACTA ACUST UNITED AC 2005. [DOI: 10.21693/1933-088x-4.4.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Teresa De Marco
- Professor of Clinical Medicine, Director, Heart Failure and Pulmonary Hypertension Program, Medical Director, Heart Transplantation, University of California, San Francisco Medical Center, San Francisco, California
| | - Dana McGlothin
- Assistant Clinical Professor of Medicine, Associate Director, Pulmonary Hypertension Program, University of California, San Francisco Medical Center, San Francisco, California
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Borbély A, van der Velden J, Papp Z, Bronzwaer JGF, Edes I, Stienen GJM, Paulus WJ. Cardiomyocyte stiffness in diastolic heart failure. Circulation 2005; 111:774-81. [PMID: 15699264 DOI: 10.1161/01.cir.0000155257.33485.6d] [Citation(s) in RCA: 385] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heart failure with preserved left ventricular (LV) ejection fraction (EF) is increasingly recognized and usually referred to as diastolic heart failure (DHF). Its pathogenetic mechanism remains unclear, partly because of a lack of myocardial biopsy material. Endomyocardial biopsy samples obtained from DHF patients were therefore analyzed for collagen volume fraction (CVF) and sarcomeric protein composition and compared with control samples. Single cardiomyocytes were isolated from these biopsy samples to assess cellular contractile performance. METHODS AND RESULTS DHF patients (n=12) had an LVEF of 71+/-11%, an LV end-diastolic pressure (LVEDP) of 28+/-4 mm Hg, and no significant coronary artery stenoses. DHF patients had higher CVFs (7.5+/-4.0%, P<0.05) than did controls (n=8, 3.8+/-2.0%), and no conspicuous changes in sarcomeric protein composition were detected. Cardiomyocytes, mechanically isolated and treated with Triton X-100 to remove all membranes, were stretched to a sarcomere length of 2.2 microm and activated with solutions containing varying [Ca2+]. Compared with cardiomyocytes of controls, cardiomyocytes of DHF patients developed a similar total isometric force at maximal [Ca2+], but their resting tension (F(passive)) in the absence of Ca2+ was almost twice as high (6.6+/-3.0 versus 3.5+/-1.7 kN/m2, P<0.001). F(passive) and CVF combined yielded stronger correlations with LVEDP than did either alone. Administration of protein kinase A (PKA) to DHF cardiomyocytes lowered F(passive) to control values. CONCLUSIONS DHF patients had stiffer cardiomyocytes, as evident from a higher F(passive) at the same sarcomere length. Together with CVF, F(passive) determined in vivo diastolic LV dysfunction. Correction of this high F(passive) by PKA suggests that reduced phosphorylation of sarcomeric proteins is involved in DHF.
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Affiliation(s)
- Attila Borbély
- Laboratory for Physiology, Institute for Cardiovascular Research, VUMC, Amsterdam, The Netherlands
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27
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Turner MS, Bleasdale RA, Mumford CE, Frenneaux MP, Morris-Thurgood JA. Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration. BRITISH HEART JOURNAL 2004; 90:502-5. [PMID: 15084543 PMCID: PMC1768222 DOI: 10.1136/hrt.2003.011759] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess whether patients with congestive heart failure (CHF) and a normal QRS duration can benefit from left ventricular (VDD-LV) pacing. DESIGN Cardiac resynchronisation is reserved for patients with a broad QRS duration on the premise that systolic resynchronisation is the mechanism of benefit, yet improvement from pacing correlates poorly with QRS duration. In CHF patients with a broad QRS duration, those with a high resting pulmonary capillary wedge pressure (PCWP) > 15 mm Hg benefit. In this acute haemodynamic VDD-LV pacing study, patients with CHF with a normal QRS duration were divided into two groups--patients with a resting PCWP > 15 mm Hg and patients with a resting PCWP < 15 mm Hg--to determine whether benefit is predicted by a high resting PCWP. PATIENTS 20 patients with CHF, New York Heart Association functional class IIb-IV, all with a normal QRS duration (< or = 120 ms). INTERVENTIONS Temporary pacing wires were positioned to enable VDD-LV pacing and a pulmonary artery catheter was inserted for measurement of PCWP, right atrial pressure, and cardiac output. RESULTS In patients with a PCWP > 15 mm Hg (n = 10), cardiac output increased from 3.9 (1.5) to 4.5 (1.65) l/min (p < 0.01), despite a fall in PCWP from 24.7 (7.1) to 21.0 (6.2) mm Hg (p < 0.001). In patients with a PCWP < 15 mm Hg there was no change in PCWP or cardiac output. Combined data showed that PCWP decreased from 17.0 (9.1) to 15.3 (7.7) mm Hg during VDD-LV pacing (p < 0.014) and cardiac output increased non-significantly from 4.7 (1.5) to 4.9 (1.5) (p = 0.125). CONCLUSIONS Patients with CHF with a normal QRS duration and PCWP > 15 mm Hg derive acute haemodynamic benefit from VDD-LV pacing.
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Affiliation(s)
- M S Turner
- Department of Cardiology, Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, UK
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Allemann Y, Rotter M, Hutter D, Lipp E, Sartori C, Scherrer U, Seiler C. Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude. Am J Physiol Heart Circ Physiol 2004; 286:H856-62. [PMID: 14604853 DOI: 10.1152/ajpheart.00518.2003] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In pulmonary hypertension right ventricular pressure overload leads to abnormal left ventricular (LV) diastolic function. Acute high-altitude exposure is associated with hypoxia-induced elevation of pulmonary artery pressure particularly in the setting of high-altitude pulmonary edema. Tissue Doppler imaging (TDI) allows assessment of LV diastolic function by direct measurements of myocardial velocities independently of cardiac preload. We hypothesized that in healthy mountaineers, hypoxia-induced pulmonary artery hypertension at high altitude is quantitatively related to LV diastolic function as assessed by conventional and TDI Doppler methods. Forty-one healthy subjects (30 men and 11 women; mean age 41 ± 12 yr) underwent transthoracic echocardiography at low altitude (550 m) and after a rapid ascent to high altitude (4,559 m). Measurements included the right ventricular to right atrial pressure gradient (ΔPRV-RA), transmitral early ( E) and late ( A) diastolic flow velocities and mitral annular early ( Em) and late ( Am) diastolic velocities obtained by TDI at four locations: septal, inferior, lateral, and anterior. At a high altitude, ΔPRV-RA increased from 16 ± 7to44 ± 15 mmHg ( P < 0.0001), whereas the transmitral E-to- A ratio ( E/ A ratio) was significantly lower (1.11 ± 0.27 vs. 1.41 ± 0.35; P < 0.0001) due to a significant increase of A from 52 ± 15 to 65 ± 16 cm/s ( P = 0.0001). ΔPRV-RA and transmitral E/ A ratio were inversely correlated ( r2 = 0.16; P = 0.0002) for the whole spectrum of measured values (low and high altitude). Diastolic mitral annular motion interrogation showed similar findings for spatially averaged (four locations) as well as for the inferior and septal locations: Am increased from low to high altitude (all P < 0.01); consequently, Em/ Am ratio was lower at high versus low altitude (all P < 0.01). These intraindividual changes were reflected interindividually by an inverse correlation between ΔPRV-RA and Em/ Am (all P < 0.006) and a positive association between ΔPRV-RA and Am (all P < 0.0009). In conclusion, high-altitude exposure led to a two- to threefold increase in pulmonary artery pressure in healthy mountaineers. This acute increase in pulmonary artery pressure led to a change in LV diastolic function that was directly correlated with the severity of pulmonary hypertension. However, in contrast to patients suffering from some form of cardiopulmonary disease and pulmonary hypertension, in these healthy subjects, overt LV diastolic dysfunction was not observed because it was prevented by augmented atrial contraction. We propose the new concept of compensated diastolic (dys)function.
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Affiliation(s)
- Yves Allemann
- Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland
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Thaman R, Murphy RT, Firoozi S, Hamid SM, Gimeno JR, Sachdev B, Paul V, Rowland E, Frenneaux MP, Elliott PM. Restrictive transmitral filling patterns predict improvements in left ventricular function after biventricular pacing. Heart 2003; 89:1087-8. [PMID: 12923039 PMCID: PMC1767855 DOI: 10.1136/heart.89.9.1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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