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Wright SP, Dawkins TG. How preserved is right ventricular reserve in hypoxia? J Physiol 2024. [PMID: 38477030 DOI: 10.1113/jp286397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Stephen P Wright
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Tony G Dawkins
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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2
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Ouyang R, Leng S, Chen L, Ma Y, Hu L, Sun A, Wang Q, Zhao X, Tan RS, Guo C, Yao X, Zhong L, Zhong Y. Assessment of right ventricular diastolic function in pediatric patients with repaired tetralogy of Fallot by cardiovascular magnetic resonance and echocardiography. Eur Radiol 2024:10.1007/s00330-023-10538-x. [PMID: 38180528 DOI: 10.1007/s00330-023-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Cardiovascular magnetic resonance (CMR) imaging is routinely performed for assessing right ventricular (RV) systolic but not diastolic function. We aimed to investigate CMR-based assessment of RV diastolic function in pediatric patients with repaired tetralogy of Fallot (rTOF), compared to transthoracic echocardiography (TTE) measurements. METHODS A total of 130 consecutive pediatric patients with rTOF who underwent clinically indicated CMR and same-day TTE were included. Forty-three controls were recruited. Phase-contrast images were used to measure trans-tricuspid valve flow velocities during early (E) and late diastolic (A) phases (measured in cm/s). Feature tracking of the tricuspid annulus was performed to derive early (e') and late diastolic (a') myocardial velocities (measured in cm/s). RV diastolic function was evaluated by E/A ratio, E/e' ratio, and E-wave deceleration time (measured in milliseconds). Regression analyses were utilized to identify potential variables associated with RV diastolic dysfunction (DD). The performance of CMR-derived parameters in diagnosing RV DD was assessed using receiver-operating characteristic analyses. RESULTS Good agreement was found between CMR and TTE measurements (ICC 0.70-0.89). Patients with RV DD (n = 67) showed significantly different CMR-derived parameters including E and e' velocities, and E/A and E/e' ratio, compared to patients without DD (n = 63) (all p < 0.05). CMR-derived E and e' velocities and E/e' ratio were independent predictors of RV DD. E/e' of 5.8 demonstrated the highest discrimination of RV DD (AUC 0.76, sensitivity 70%, specificity 86%). CONCLUSIONS CMR-derived parameters showed good agreement with TTE parameters in determining RV DD. CMR-derived E/e' was proved to be the most effective in identifying RV DD. CLINICAL RELEVANCE STATEMENT This study demonstrated the feasibility and efficacy of CMR in assessing diastolic function in pediatric patients. RV DD was presented in over half of patients according to current TTE guidelines, highlighting the need for assessing RV diastolic function during follow-up. KEY POINTS • Routinely acquired cine and phase-contrast cardiovascular magnetic resonance (CMR) images yielded right ventricular (RV) diastolic parameters which demonstrated good agreement with transthoracic echocardiography (TTE) measurements. • There was a high prevalence of RV diastolic function impairment in pediatric patients with repaired tetralogy of Fallot (rTOF). • CMR is a reliable complementary modality of TTE for RV diastolic function evaluation.
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Affiliation(s)
- Rongzhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Yanyan Ma
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Aimin Sun
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Qian Wang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Chen Guo
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaofen Yao
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Department of Biomedical Engineering, National University of Singapore, Engineering Drive 3 Block 4, Singapore, 117583, Singapore.
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China.
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Sullivan RD, Shults NV, Suzuki YJ. Case Report: Two Case Reports of Pulmonary Hypertension after mRNA COVID-19 Vaccination. Diseases 2023; 11:114. [PMID: 37754310 PMCID: PMC10528902 DOI: 10.3390/diseases11030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND We herein report two cases of sudden onset symptomatic pulmonary hypertension after coronavirus disease 2019 (COVID-19) vaccination. CASE SUMMARY Pulmonary hypertension in previously healthy adult males occurred within three weeks of receiving the second dose of the Pfizer (BNT162b2) mRNA COVID-19 vaccine from different lots. Both patients experienced a sudden onset of severe fatigue and dyspnea on exertion with negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing. The diagnosis was made by serial transthoracic echocardiography in the first case and by both transthoracic echocardiography and right heart catheterization in the second. Both cases resulted in functional limitations and likely permanent organ damage. No evidence of pulmonary emboli was detected in either case. DISCUSSION Pulmonary hypertension is a serious disease characterized by damage to lung vasculature and restricted blood flow through narrowed arteries from the right to left heart. The onset of symptoms is typically insidious, progressive and incurable, leading to right heart failure and premature death. The World Health Organization (WHO) classifies pulmonary hypertension into five categories and recently re-defined it as a resting mean pulmonary artery pressure greater than 20 mmHg. Sudden onset pulmonary hypertension would only be expected in the settings of surgical pneumonectomy or massive pulmonary emboli with compromise of at least 50% of the lung vasculature. We present here two novel cases of sudden onset pulmonary hypertension without evidence of pulmonary emboli, both of which occurred after receiving a COVID-19 mRNA vaccine.
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Affiliation(s)
| | - Nataliia V. Shults
- Department of Biology, Georgetown University, Washington, DC 20007, USA;
| | - Yuichiro J. Suzuki
- Department of Pharmacology and Physiology, Georgetown University Medical Center, Washington, DC 20007, USA
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4
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Nägele MP, Flammer AJ. Heart Failure After Right Ventricular Myocardial Infarction. Curr Heart Fail Rep 2022; 19:375-385. [PMID: 36197627 DOI: 10.1007/s11897-022-00577-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE OF REVIEW Heart failure (HF) after right ventricular myocardial infarction (RVMI) is common and complicates its clinical course. This review aims to provide a current overview on the characteristic features of RV failure with focus on acute management. RECENT FINDINGS While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients. HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
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Affiliation(s)
- Matthias P Nägele
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland
| | - Andreas J Flammer
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland.
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5
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Kanwar MK, Everett KD, Gulati G, Brener MI, Kapur NK. Epidemiology and management of right ventricular-predominant heart failure and shock in the cardiac intensive care unit. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:584-594. [PMID: 35767583 DOI: 10.1093/ehjacc/zuac063] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
Cardiogenic shock from left ventricular failure is a common presentation in the intensive care unit. In contrast, right ventricular (RV)-predominant heart failure (HF) causing shock is less well recognized. We review the epidemiology and mechanisms of RV-predominant HF and discuss pharmacologic and device-based approaches for the management of this challenging clinical problem.
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Affiliation(s)
- Manreet K Kanwar
- Department of Medicine, Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, USA
| | - Kay D Everett
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
| | - Gaurav Gulati
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
| | - Michael I Brener
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Navin K Kapur
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
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Liu W, Nguyen-Truong M, LeBar K, Labus KM, Gray E, Ahern M, Neelakantan S, Avazmohammadi R, McGilvray KC, Puttlitz CM, Wang Z. Multiscale Contrasts Between the Right and Left Ventricle Biomechanics in Healthy Adult Sheep and Translational Implications. Front Bioeng Biotechnol 2022; 10:857638. [PMID: 35528212 PMCID: PMC9068898 DOI: 10.3389/fbioe.2022.857638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Cardiac biomechanics play a significant role in the progression of structural heart diseases (SHDs). SHDs alter baseline myocardial biomechanics leading to single or bi-ventricular dysfunction. But therapies for left ventricle (LV) failure patients do not always work well for right ventricle (RV) failure patients. This is partly because the basic knowledge of baseline contrasts between the RV and LV biomechanics remains elusive with limited discrepant findings. The aim of the study was to investigate the multiscale contrasts between LV and RV biomechanics in large animal species. We hypothesize that the adult healthy LV and RV have distinct passive anisotropic biomechanical properties. Ex vivo biaxial tests were performed in fresh sheep hearts. Histology and immunohistochemistry were performed to measure tissue collagen. The experimental data were then fitted to a Fung type model and a structurally informed model, separately. We found that the LV was stiffer in the longitudinal (outflow tract) than circumferential direction, whereas the RV showed the opposite anisotropic behavior. The anisotropic parameter K from the Fung type model accurately captured contrasting anisotropic behaviors in the LV and RV. When comparing the elasticity in the same direction, the LV was stiffer than the RV longitudinally and the RV was stiffer than the LV circumferentially, suggesting different filling patterns of these ventricles during diastole. Results from the structurally informed model suggest potentially stiffer collagen fibers in the LV than RV, demanding further investigation. Finally, type III collagen content was correlated with the low-strain elastic moduli in both ventricles. In summary, our findings provide fundamental biomechanical differences between the chambers. These results provide valuable insights for guiding cardiac tissue engineering and regenerative studies to implement chamber-specific matrix mechanics, which is particularly critical for identifying biomechanical mechanisms of diseases or mechanical regulation of therapeutic responses. In addition, our results serve as a benchmark for image-based inverse modeling technologies to non-invasively estimate myocardial properties in the RV and LV.
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Affiliation(s)
- Wenqiang Liu
- Cardiovascular Biomechanics Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Michael Nguyen-Truong
- Cardiovascular Biomechanics Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Kristen LeBar
- Cardiovascular Biomechanics Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Kevin M. Labus
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Elisabeth Gray
- Cardiovascular Biomechanics Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Matt Ahern
- Cardiovascular Biomechanics Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Sunder Neelakantan
- Computation Cardiovascular Bioengineering Lab, Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - Reza Avazmohammadi
- Computation Cardiovascular Bioengineering Lab, Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
- Computation Cardiovascular Bioengineering Lab, J. Mike Walker ’66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, United States
- Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX, United States
| | - Kirk C. McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, United States
- Orthopaedic Bioengineering Research Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Christian M. Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, United States
- Orthopaedic Bioengineering Research Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
| | - Zhijie Wang
- Cardiovascular Biomechanics Laboratory, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, United States
- Cardiovascular Biomechanics Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, United States
- *Correspondence: Zhijie Wang,
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7
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Fresiello L, Najar A, Brynedal Ignell N, Zieliński K, Rocchi M, Meyns B, Perkins IL. Hemodynamic characterization of the Realheart® total artificial heart with a hybrid cardiovascular simulator. Artif Organs 2022; 46:1585-1596. [PMID: 35231138 DOI: 10.1111/aor.14223] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/28/2021] [Accepted: 02/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Heart failure is a growing health problem worldwide. Due to the lack of donor hearts there is a need for alternative therapies, such as total artificial hearts (TAHs). The aim of this study is to evaluate the hemodynamic performance of the Realheart® TAH, a new 4-chamber cardiac prosthesis device. METHODS The Realheart® TAH was connected to a hybrid cardiovascular simulator with inflow connections at left/right atrium, and outflow connections at the ascending aorta/pulmonary artery. The Realheart® TAH was tested at different pumping rates and stroke volumes. Different systemic resistances (20.0-16.7-13.3-10.0 Wood units), pulmonary resistances (6.7-3.3-1.7 Wood units), and pulmonary/systemic arterial compliances (1.4-0.6 mL/mmHg) were simulated. Tests were also conducted in static conditions, by imposing predefined values of preload-afterload across the artificial ventricle. RESULTS The Realheart® TAH allows the operator to finely tune the delivered flow by regulating the pumping rate and stroke volume of the artificial ventricles. For a systemic resistance of 16.7 Wood units the TAH flow ranges from 2.7±0.1 to 6.9±0.1 L/min. For a pulmonary resistance of 3.3 Wood units the TAH flow ranges from 3.1±0.0 to 8.2±0.3 L/min. The Realheart® TAH delivered a pulse pressure ranging between ~25 mmHg and ~50 mmHg for the tested conditions. CONCLUSIONS The Realheart® TAH offers great flexibility to adjust the output flow and delivers good pressure pulsatility in the vessels. A low sensitivity of device flow to the pressure drop across it was identified and a new version is under development to counteract this.
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Affiliation(s)
- Libera Fresiello
- Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Azad Najar
- R&D, Scandinavian Real Heart AB, Västerås, Sweden
| | | | - Krzysztof Zieliński
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Maria Rocchi
- Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
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8
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Lakin R, Debi R, Yang S, Polidovitch N, Goodman JM, Backx PH. Differential negative effects of acute exhaustive swim exercise on the right ventricle are associated with disproportionate hemodynamic loading. Am J Physiol Heart Circ Physiol 2021; 320:H1261-H1275. [PMID: 33416456 DOI: 10.1152/ajpheart.00603.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute exhaustive endurance exercise can differentially impact the right ventricle (RV) versus the left ventricle (LV). However, the hemodynamic basis for these differences and its impact on postexercise recovery remain unclear. Therefore, we assessed cardiac structure and function along with hemodynamic properties of mice subjected to single bouts (216 ± 8 min) of exhaustive swimming (ES). One-hour after ES, LVs displayed mild diastolic impairment compared with that in sedentary (SED) mice. Following dobutamine administration to assess functional reserve, diastolic and systolic function were slightly impaired. Twenty-four hours after ES, LV function was largely indistinguishable from that in SED. By contrast, 1-h post swim, RVs showed pronounced impairment of diastolic and systolic function with and without dobutamine, which persisted 24 h later. The degree of RV impairment correlated with the time-to-exhaustion. To identify hemodynamic factors mediating chamber-specific responses to ES, LV pressure was recorded during swimming. Swimming initiated immediate increases in heart rates (HRs), systolic pressure, dP/dtmax and -dP/dtmin, which remained stable for ∼45 min. LV end-diastolic pressures (LVEDP) increased to ≥45 mmHg during the first 10 min and subsequently declined. After 45 min, HR and -dP/dtmin declined, which correlated with gradual elevations in LVEDP (to ∼45 mmHg) as mice approached exhaustion. All parameters rapidly normalized postexercise. Consistent with human studies, our findings demonstrate a disproportionate negative impact of acute exhaustive exercise on RVs that persisted for at least 24 h. We speculate that the differential effects of exhaustive exercise on the ventricles arise from a ∼2-fold greater hemodynamic load in the RV than in LV originating from profound elevations in LVEDPs as mice approach exhaustion.NEW & NOTEWORTHY Acute exhaustive exercise differentially impacts the right ventricle (RV) versus left ventricle (LV), yet the underlying hemodynamic basis remains unclear. Using pressure-volume analyses and pressure-telemetry implantation in mice, we confirmed a marked disproportionate and persistent negative impact of exhaustive exercise on the RV. These differences in responses of the ventricles to exhaustive exercise are of clinical relevance, reflecting ∼2-fold greater hemodynamic RV loads versus LVs arising from massive (∼45 mmHg) increases in LV end-diastolic pressures at exhaustion.
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Affiliation(s)
- Robert Lakin
- Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Biology, York University, Toronto, Ontario, Canada.,Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Ryan Debi
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Sibao Yang
- Department of Biology, York University, Toronto, Ontario, Canada.,Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Nazari Polidovitch
- Department of Biology, York University, Toronto, Ontario, Canada.,Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Jack M Goodman
- Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Peter H Backx
- Department of Biology, York University, Toronto, Ontario, Canada.,Division of Cardiology, University Health Network, Toronto, Ontario, Canada
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Guazzi M. The alarming association between right ventricular dysfunction and outcome: aetiology matters. Eur Heart J 2020; 41:1283-1285. [PMID: 32091091 DOI: 10.1093/eurheartj/ehaa080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Abstract
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Affiliation(s)
- Marco Guazzi
- Cardiology University Department and Heart Failure Unit, University of Milano School of Medicine, I.R.C.C.S. Policlinico San Donato, Piazza Malan, 1, 20097, San Donato Milanese, Milano, Italy
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