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Puwanant S, Park M, Popović ZB, Tang WHW, Farha S, George D, Sharp J, Puntawangkoon J, Loyd JE, Erzurum SC, Thomas JD. Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 2010; 121:259-66. [PMID: 20048214 DOI: 10.1161/circulationaha.108.844340] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We tested the hypothesis that right ventricular (RV) pressure overload affects RV function and further influences left ventricular (LV) geometry, which adversely affects LV twist mechanics and segmental function. METHODS AND RESULTS Echocardiographic images were prospectively acquired in 44 patients (age, 46+/-12 years; 82% women) with evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure, 71+/-23 mm Hg) and in 44 age- and gender-matched healthy subjects. Patients with intrinsic LV diseases were excluded. RV lateral wall longitudinal strain (LS) and interventricular septal (IVS) LS were reduced in the pulmonary hypertension group compared with control subjects (-15.9+/-7.6% versus -25.5+/-6.1%, P<0.001; and -17.3+/-4.4% versus -20.2+/-3.9%, P=0.002, respectively), whereas LV lateral wall LS was preserved. RV lateral wall LS and IVS LS, but not LV lateral wall LS, correlated with pulmonary artery systolic pressure (r=0.56, P<0.01; r=0.32, P<0.01) and LV eccentricity index (r=0.57, P<0.01; r=0.57, P<0.01). IVS and LV lateral wall circumferential strain (CS) were both reduced in the pulmonary hypertension group. Although IVS CS and LV lateral wall CS correlated with pulmonary artery systolic pressure and LV eccentricity index, after adjustment of CS for LV eccentricity index, differences between groups persisted for IVS CS (P<0.01) but not LV lateral wall CS (P=0.09). LV torsion was decreased in patients with pulmonary hypertension compared with control subjects (9.6+/-4.9 degrees versus 14.7+/-4.9 degrees , P<0.001). LV torsion inversely correlated with pulmonary artery systolic pressure (r=-0.39, P<0.01) and LV eccentricity index (r=-0.3, P<0.01). LV untwisting rates were similar in both groups (P=0.7). CONCLUSIONS Chronic RV pressure overload directly affects RV longitudinal systolic deformation. RV pressure overload further influences IVS and LV geometry, which impairs LV torsion and segmental LS and CS, more for the IVS than for the free wall of the LV.
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Affiliation(s)
- Sarinya Puwanant
- Department of Cardiovascular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Jörgensen K, Houltz E, Westfelt U, Ricksten SE. Left ventricular performance and dimensions in patients with severe emphysema. Anesth Analg 2007; 104:887-92. [PMID: 17377101 DOI: 10.1213/01.ane.0000258020.27849.6b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Concomitant heart dysfunction during the course of chronic obstructive pulmonary disease is well recognized. The prevailing view is that mainly the right side of the heart is involved. We evaluated left ventricular (LV) function and dimensions in patients with severe emphysema. METHODS Patients with severe emphysema undergoing lung volume reduction surgery were studied after anesthesia induction (n = 10). Non-emphysematous patients scheduled for lobectomy served as controls (n = 10). LV dimensions were measured with patients in the supine position by transesophageal two-dimensional echocardiography and systemic hemodynamics by a pulmonary artery thermodilution catheter, before and during central blood volume expansion by passive leg elevation. RESULTS Baseline cardiac index (-25%), stroke volume index (SVI, -32%) stroke work index (-34%) and LV end-diastolic area index (EDAI, -33%) were significantly (P < 0.001) lower in the emphysema group. Passive leg elevation increased SVI and LV area ejection fraction more in the emphysema group than in controls (P < 0.05). The DeltaSVI/Delta pulmonary capillary wedge pressure and the DeltaSVI/DeltaEDAI relationships were significantly (P < 0.05) higher in the emphysema group compared to controls (2.2 +/- 0.71 vs 0.6 +/- 0.2 mL/mm Hg x m2 and 5.8 +/- 0.89 vs 2.8 +/- 0.8 mL/cm2 x m2, respectively). Preload-recruitable stroke work (Deltastroke work index/DeltaEDAI), a load-independent index of systolic LV function, did not differ between the two groups. CONCLUSION The LV in patients with severe emphysema is hypovolemic, and operates on a steeper portion of the LV function curve, while indices of systolic function are not significantly impaired compared to non-emphysematous controls.
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Affiliation(s)
- Kirsten Jörgensen
- Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sakamaki F, Satoh T, Nagaya N, Kyotani S, Nakanishi N, Ishida Y. Abnormality of left ventricular sympathetic nervous function assessed by (123)I-metaiodobenzylguanidine imaging in patients with COPD. Chest 1999; 116:1575-81. [PMID: 10593779 DOI: 10.1378/chest.116.6.1575] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiac and systemic autonomic nervous function may be impaired in patients with COPD. Few reports, however, have described sympathetic nervous function of the left ventricle (LV) in COPD patients. STUDY OBJECTIVE To assess the LV sympathetic nervous function in patients with COPD using (123)I-metaiodobenzylguanidine (MIBG) imaging of the heart. DESIGN Prospective comparison of (123)I-MIBG imaging results in COPD patients and normal subjects. PARTICIPANTS Twenty-eight patients with COPD without manifest right ventricular overload and 7 volunteers without cardiopulmonary disease (control subjects). MEASUREMENTS (123)I-MIBG imaging results and plasma norepinephrine concentration were compared between the COPD and control groups. In the COPD group, pulmonary function tests were performed and all subjects were interviewed about their symptoms. RESULTS (123)I-MIBG uptake, assessed as the cardiac to mediastinal activity ratio in the delayed image, was significantly lower in the COPD group than in the control group (p < 0.05). (123)I-MIBG turnover, expressed as the washout rate (WR) of (123)I-MIBG from 15 to 240 min, was significantly higher in the COPD group than in the control group (p < 0.01). In the COPD group, patients with dyspnea showed lower cardiac to mediastinal activity ratios and higher WRs compared with patients who had mild dyspnea. The WR correlated negatively with the vital capacity/predicted value ratio, correlated negatively with the maximal voluntary ventilation volume/predicted value ratio, and correlated positively with the residual volume/total lung capacity ratio in the COPD group. The plasma norepinephrine concentration in COPD patients was higher than that in the control subjects. CONCLUSION Patients with COPD have significant sympathetic nervous impairment of the LV myocardium as a result of generalized sympathetic overactivity.
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Affiliation(s)
- F Sakamaki
- Department of Medicine, National Cardiovascular Center, Osaka, Japan.
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Charan NB, Ripley R, Carvalho P. Effect of increased coronary venous pressure on left ventricular function in sheep. RESPIRATION PHYSIOLOGY 1998; 112:227-35. [PMID: 9716306 DOI: 10.1016/s0034-5687(98)00012-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We studied the effect of increased coronary venous pressure (Pcv) on left ventricular (LV) function in nine anesthetized open-chested sheep. Pcv was increased by inflating a balloon in the coronary sinus. LV function was estimated by measuring maximum rate of change in LV pressure (dP/dt max) and LV end-diastolic pressure (LVEDP). Left anterior descending (LAD) coronary artery blood flow was measured with an electromagnetic flow probe. A control group (n=6) was studied similarly except that Pcv was not elevated. After completion of the experiment, LV wet/dry weight ratios were measured to estimate LV myocardial water content. The balloon inflation increased Pcv from 8.6+/-1.1 to 23.8+/-1.7 mmHg (mean+/-SEM), which decreased dP/dt max from 1611+/-236 at baseline to 1041+/-210 after 120 min of increased Pcv (P < 0.05). The dP/dt max in the control group did not change significantly. Heart rate, LAD flow, LVEDP, and aortic pressures were similar in two groups but the LV water content was significantly higher (P < 0.05) in the experimental group (76.2+/-1.0 vs. 79.1+/-0.5%). These data suggest that acute increases in Pcv result in LV dysfunction and that coronary vascular congestion and myocardial edema may, at least in part, be responsible for this finding.
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Affiliation(s)
- N B Charan
- Pulmonary Research Laboratory, Section of Pulmonary/Critical Care Medicine (111), VA Medical Center, Boise, Idaho 83702, USA
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Abstract
Since the publication of Bernheim's report it has been clear that the anatomic and functional integrity of each ventricle is an important determinant of the functional characteristics of the other ventricle. How the ventricles interact in health and disease has been of interest to many investigators. This article reviews and considers the structure and function of each ventricle as an independent subunit and as a unified pumping system in the healthy state and in various disease states.
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Affiliation(s)
- C A Clyne
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, Worcester 01655
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Stenberg RG, Fixler DE, Taylor AL, Corbett JR, Firth BG. Left ventricular dysfunction due to chronic right ventricular pressure overload. Resolution following percutaneous balloon valvuloplasty for pulmonic stenosis. Am J Med 1988; 84:157-61. [PMID: 2962489 DOI: 10.1016/0002-9343(88)90026-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Left ventricular dysfunction due to chronic right ventricular pressure overload is well documented in experimental animals, but is controversial in humans. Whether left ventricular dysfunction resolves following the relief of chronic right ventricular pressure overload has not been studied. In this report, rapid improvement in both right and left ventricular function following successful percutaneous balloon valvuloplasty is described in a patient with severe isolated valvular pulmonic stenosis and biventricular dysfunction. It appears that: (1) geometric distortion played a major role in his reversible left ventricular dysfunction, and (2) severe biventricular dysfunction should not be a contraindication to valvuloplasty for valvular pulmonic stenosis.
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Affiliation(s)
- R G Stenberg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235
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Mink SN, Gomez A, Whitley L, Coalson JJ. Hemodynamics in dogs with pulmonary hypertension due to emphysema. Lung 1986; 164:41-54. [PMID: 3081770 DOI: 10.1007/bf02713628] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Genovese A, Accinni A, Spadaro G, Quattrin S, Condorelli M. Myocardial hypertrophy in rats exposed to simulated high altitude. ARCHIVES INTERNATIONALES DE PHYSIOLOGIE ET DE BIOCHIMIE 1985; 93:331-8. [PMID: 2421671 DOI: 10.3109/13813458509079614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Myocardial hypertrophy in Sprague-Dawley adult rats exposed to hypobaric hypoxia (0.40 atmosphere of air/18 h daily for 7 days) in a hypobaric chamber was investigated. Changes in the myocardial mass were evaluated on the basis of the dry heart weight and expressed as mg/100 g of total body weight (mean +/- SEM). Data are presented indicating that: chronic hypobaric hypoxia causes a significant degree of myocardial hypertrophy in rats; hypertrophic process involves both ventricles (the right more than the left); removal of the hypoxic stimulus leads to the disappearance of hypertrophy when evaluated as an increase in dry heart weight; hypoxia affects the synthesis of a significant amount of connective tissue in the left ventricle, which is not exposed to pressure load. The rôle of neurohumoral factors (i.e., adrenergic stimulation and catecholamines) in the development of the ventricular hypertrophy is suggested.
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Badke FR. Left ventricular dimensions and function during exercise in dogs with chronic right ventricular pressure overload. Am J Cardiol 1984; 53:1187-93. [PMID: 6702702 DOI: 10.1016/0002-9149(84)90660-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Left ventricular (LV) dimensions and shortening at rest and during treadmill exercise were examined before and after 4 weeks of pulmonary artery (PA) constriction in 6 conscious dogs. The dogs were preinstrumented with LV and right ventricular (RV) catheters, an LV micromanometer, a PA inflatable cuff occluder and ultrasonic crystals to measure an LV anteroposterior, a septal-lateral, an apex-base and a free wall segment chord. With PA constriction, RV pressures increased from 49 +/- 4/2 +/- 1 mm Hg (systolic/end-diastolic) to 104 +/- 5/2 +/- 1 at rest and from 71 +/- 9/2 +/- 1 to 133 +/- 8/14 +/- 2 at peak exercise (mean +/- standard error of the mean). Heart rate, LV pressure and LV dP/dt were similar before and after RV pressure overload at rest and with exercise. During exercise at control, systolic shortening increased significantly in all chords. With chronic PA constriction at rest, shortening of all chords also remained normal despite decreases in end-diastolic dimensions, which were most marked in the septal-lateral chord (23% decrease, p less than 0.01). However, during exercise in the presence of RV pressure overload, septal-lateral shortening decreased 46% (p less than 0.01) despite increases in systolic shortening in the other chords similar to the control response. Therefore, although LV function at rest in chronic RV pressure overload is normal, exercise may induce regional abnormalities of LV contraction that appear to be mediated by a reduced contribution of the ventricular septum to LV ejection.
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Genovese A, Latte S, Betocchi S, Bozzaotre M, Giunta A, Chiariello M. Cardiac hypertrophy in the absence of pressure overload: an experimental and clinical report. Clin Exp Pharmacol Physiol 1984; 11:91-5. [PMID: 6232026 DOI: 10.1111/j.1440-1681.1984.tb00244.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A stimulated altitude of 7000 m was applied in rats chronically exposed to hypoxia in a hypobaric chamber. In these experimental conditions the contralateral ventricle not exposed to pressure overload (that is, the left) showed a significant degree of hypertrophy. The hypoxic stimulus did not affect systemic artery pressure or the heart rate. Chronic adrenergic stimulation performed in the rat treated with low doses of isoprenaline (a direct stimulating adrenergic drug) or with tyramine (primarily a releaser of endogenous catecholamines) induced hypertrophy of the right ventricle, left ventricle, and interventricular septum without modifying the haemodynamic parameters mentioned above. The development of ventricular hypertrophy in the absence of pressure overload is stressed. A role for neurohumoral factors (that is, adrenergic stimulation and catecholamines) in the development of ventricular hypertrophy is suggested.
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Espolita Santos J, Lopez-negrete Fernandez J, Fernandez Bustillo E, Lopez de la Iglesia J, Enriquez Martin J, Iglesias Cubero G, Tomas Mauri J, Rodriguez Reguero J, Soriano Vela E. Intervalos sistolicos. Relacion PPE/PE en el cor pulmonale cronico. Arch Bronconeumol 1983. [DOI: 10.1016/s0300-2896(15)32305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Larson DF, Womble J, Copeland J, Russell DH, Shumway NE. Concurrent left and right ventricular hypertrophy in dog models of right ventricular overload. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)38981-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jacobstein MD, Hirschfeld SS, Winnie G, Doershuk C, Liebman J. Ventricular interdependence in severe cystic fibrosis. A two-dimensional echocardiographic study. Chest 1981; 80:399-404. [PMID: 7273891 DOI: 10.1378/chest.80.4.399] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A variety of mechanisms have been implicated in the development of left ventricular dysfunction in patients with chronic cor pulmonale. A two-dimensional echocardiographic study of cystic fibrosis (CF) patients with severe cor pulmonale was undertaken to evaluate the effects of long-term pulmonary abnormalities on right and left ventricular geometry. Ten patients with severe obstructive pulmonary disease secondary to CF underwent evaluation by a mechanical sector scanner from the long axis, short axis, and four chambered views. All patients manifested right heart failure. Eight had clinical scores less than 40 and died within six months of the initial examination. All patients were receiving diuretics, and six were taking digoxin at the time of the study. The most striking echographic feature was flattening or compression of the left ventricle along its minor dimension by a massively dilated right ventricle. Compression of the left ventricle and additional abnormalities of interventricular septal motion resulted in dyskinetic contraction and relaxation that could contribute to a diminished stroke volume. Massive right ventricular enlargement appears to be a major factor producing left ventricular dysfunction in chronic cor pulmonale.
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Brinker JA, Weiss JL, Lappé DL, Rabson JL, Summer WR, Permutt S, Weisfeldt ML. Leftward septal displacement during right ventricular loading in man. Circulation 1980; 61:626-33. [PMID: 7353253 DOI: 10.1161/01.cir.61.3.626] [Citation(s) in RCA: 332] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Chipps BE, Alderson PO, Roland JM, Yang S, van Aswegen A, Martinez CR, Rosenstein BJ. Noninvasive evaluation of ventricular function in cystic fibrosis. J Pediatr 1979; 95:379-84. [PMID: 469660 DOI: 10.1016/s0022-3476(79)80510-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cardiac function of 21 patients with cystic fibrosis was studied using radionuclides and M-mode echocardiography. The patients (mean age 13.2 years, range 4 to 27) had a wide range of clinical and pulmonary function abnormalities (mean Shwachman-Kulczycki score 62.1). Decreased right ventricular ejection fraction was found in 13 of 18 patients (72%); an additional four patients had abnormal septal motion on ECHO. Left ventricular ejection fraction was abnormal at rest in four patients (19%); an additional four patients had borderline low LVEF. The LV pre-ejection period to ejection time ratio increased significantly (i.e., worsening LV performance) with deterioration of S-K score, chest radiograph score, and forced expiratory volume in 1 second. Three of eight patients with normal LVEF at rest had an abnormal response to supine bicycle exercise: LVEF fell in two patients and was unchanged in one. Thus evidence of LV dysfunction was observed in seven of 21 (33%) of the patients; four at rest and in three only during exercise.
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Allen HD, Taussig LM, Gaines JA, Sahn DJ, Goldberg SJ. Echocardiographic profiles of the long-term cardiac changes in cystic fibrosis. Chest 1979; 75:428-33. [PMID: 446129 DOI: 10.1378/chest.75.4.428] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In this echocardiographic study, assessment of the heart in children with cystic fibrosis has shown that changes occur in not only the right ventricle but also in the left ventricle and aorta, as compared with normal. Echocardiograms could be successfully performed in 34 of 37 patients. The thickness of the right ventricular anterior wall and the dimension of the right ventricular cavity were abnormal, even in patients with mild disease (National Institutes of Health [NIH] score for severity of disease of 85 or greater). Larger, older children with lower NIH score had disproportionately larger right ventricular anterior walls and cavities. The thickness of the septal wall, the thickness of the left ventricular posterior wall, and the aortic dimensions were increased in those with severe disease. The dimensions of the left ventricular cavity for the population were slightly but significantly smaller than normal in systole and in diastole throughout the course of the disease. This study demonstrates that echocardiography is an effective noninvasive means of assessing the long-term changes in children with cystic fibrosis. These changes occur in both sides of the heart and appear to worsen as the disease progresses.
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Christianson LC, Shah A, Fisher VJ. Quantitative left ventricular cineangiography in patients with chronic obstructive pulmonary disease. Am J Med 1979; 66:399-404. [PMID: 433945 DOI: 10.1016/0002-9343(79)91058-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
The presence or absence of left ventricular dysfunction in chronic obstructive pulmonary disease has been debated for decades. I have reviewed the following evidence pertaining to this topic: (1) left ventricular pathologic abnormalities; (2) the methods used to determine left ventricular performance; (3) specific abnormalities of left ventricular function as revealed by systolic time intervals, left ventricular end-diastolic pressure, ejection fraction, isovolumic indices, and left ventricular function curves; and (4) pertinent experimental data. The bulk of the evidence indicates that the clinical symtoms of left-sided failure are unreliable in those with obstructive disease of the airways and that the great majority of patients have normal left ventricular function, once other causes are excluded. A small group of patients have some abnormalities in left ventricular performance, but these have not been clinically significant. The ultimate importance of such abnormalities awaits future investigation.
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Smith DE, Bissett JK, Phillips JR, Doherty JE, Murphy ML. Improved right ventricular systolic time intravals after digitalis in patients with cor pulmonale and chronic obstructive pulmonary disease. Am J Cardiol 1978; 41:1299-1304. [PMID: 665537 DOI: 10.1016/0002-9149(78)90889-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
A clinicopathological study of 21 patients who died as a result of chronic airways obstruction was carried out. Thirteen patients had been in right ventricular failure for at least one year before death and the other eight patients did not have right ventricular failure. The patients with long-standing right ventricular failure died at a younger age, on average, than those without failure. There were no significant quantitative differences between the two groups in the length of history of chest disease, blood gas estimations, respiratory function tests or degree of polycythaemia. The group with right ventricular failure had significantly larger mean right and left ventricular weights than the group without failure, but there were no significant differences in amounts of emphysema, size of bronchial mucous glands, proportion of small airways lumen in the lung or number of thick-walled peripheral lung vessels between the two groups. The findings did not support the division of this series of patients, with fatal chronic airways obstruction, into two distinct groups broadly defined as 'emphysematous' and 'bronchitic', either clinically or pathologically. A history of right ventricular failure correlated well with the finding of right ventricular hypertrophy at necropsy. Electrocardiographic evidence of right ventricular hypertrophy was found to correspond with the size of the right ventricle at necropsy in 66% of cases. The radiographic diagnosis of emphysema proved an accurate assessment when compared to the necropsy findings, and radiographic estimations of right ventricular enlargement were accurate in 65% of cases. Histological evidence of acute bronchitis was present in 20 of the 21 patients (95%), and five patients showed histological evidence of minor pulmonary thromboembolism. Ten patients in the series showed an increase in the weight of the left ventricular as well as the right ventricle.
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Matthay RA, Ellis JH, Steele PP. Effect of dextran loading on left ventricular performance in chronic obstructive pulmonary disease. Am Heart J 1976; 92:730-6. [PMID: 998479 DOI: 10.1016/s0002-8703(76)80009-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The status of left ventricular function in patients with chronic obstructive pulmonary disease remains controversial. With a radionuclide technique left ventricular ejection fraction, left ventricular end-diastolic volume, cardiac output, and stroke volume were measured at rest and following infusion of dextran in 23 men with severe COPD. Resting, mean LVEF was normal in 19 subjects with COPD alone; four with COPD and coronary artery disease had a depressed mean LVEF. Left ventricular end-diastolic volume index and pulmonary capillary wedge pressure were both normal at rest indicating that the left ventricle was not volume underloaded. There was a normal response to dextran infusion (750 ml.) with no deterioration in LVEF and a significant increase in cardiac index, stroke volume index, LVEDVI, and PCW. These data suggest that at rest and following volume loading with dextran left ventricular function is normal in patients with COPD.
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Bahler RC. Editorial: Assessment of left ventricular function in chronic obstructive pulmonary disease. Chest 1975; 68:132-3. [PMID: 1149542 DOI: 10.1378/chest.68.2.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Unger K, Shaw D, Karliner JS, Crawford M, O'Rourke RA, Moser KM. Evaluation of left ventricular performance in acutely ill patients with chronic obstructive lung disease. Chest 1975; 68:135-42. [PMID: 1149544 DOI: 10.1378/chest.68.2.135] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Among 28 patients with chronic obstructive pulmonary disease (COPD) with increasing dyspnea, the resting mean pulmonary arterial wedge pressure was elevated (greater than 12mm Hg) in 4 and became abnormal with exercise in 3 other subjects. Stroke volume index was reduced (less than 36 ml/beat/M2) in 16 of 26 patients (62 percent). The resting pre-ejection period index was prolonged (greater than 144 msec) in 17 patients (65 percent), while the left ventricular (LV) ejection time index was reduced (less than 408 msec) in 23 patients (88 percent). The ratio of the pre-ejection period to the LV ejection time was within the normal range (0.309 to 0.381) in only 3 of 26 patients (12 percent). Echocardiographic measurements of LV function were normal in nine patients, seven of whom had one or more abnormal values for systolic time intervals (STIs). These data suggest that reduced LV filing results in abnormal values for STIs in patients with COPD, and therefore that in such patients STIs are not accurate indices of LV function.
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Steele P, Ellis JH, Van Dyke D, Sutton F, Creagh E, Davies H. Left ventricular ejection fraction in severe chronic obstructive airways disease. Am J Med 1975; 59:21-8. [PMID: 1138548 DOI: 10.1016/0002-9343(75)90317-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The subject of left ventricular involvement in chronic obstructive airways disease is controversial. We measured left ventricular ejection fraction (LVEF) in 120 patients with severe chronic obstructive airways disease, 92 of them acutely decompensated and 28 stable. A bedside radionuclide technic using a scintillation probe was used to measure LVEF. Of the 28 patients with acute respiratory failure, LVEF was normal (larger than or equal to 55 per cent) in 60 and subnormal in 32. Of the 28 patients with stable chronic obstructive airways disease, LVEF was normal in 12 and low in 16. Coronary artery disease could be demonstrated clinically or at autopsy in 13 of the patients with acute and in 7 of the patients with stable chronic obstructive airways disease. LVEF was 28 plus or minus 10.4 per cent (average plus or minus SEM) in the patients with acute chronic obstructive airways disease and coronary artery disease which was significantly different (P smaller than 0.001) from LVEF in patients without coronary artery disease (61 plus or minus 1.9 per cent). In the patients stable with chronic obstructive airways disease and coronary artery disease, LVEF was (42 plus or minus 3.5 per cent), significantly different (P smaller than 0.001) from LVEF in those without coronary artery disease (55 plus or minus 2.1 per cent). There was no relationship between LVEF and arterial oxygen, or carbon dioxide tension, or pH. Results suggest that LVEF is normal in patients with severe lung disease alone and that reduced LVEF in patients with chronic obstructive airways disease can reasonably be ascribed to coronary artery disease.
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Monset-Couchard M, Mason CV, Moss AJ. Cor pulmonale in children. CURRENT PROBLEMS IN PEDIATRICS 1975; 5:3-31. [PMID: 123496 DOI: 10.1016/s0045-9380(75)80002-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rahlf G, Komori R. [The left ventricle in chronic cor plumonale (author's transl)]. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1975; 366:237-47. [PMID: 124106 DOI: 10.1007/bf00427412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The volume of both ventricles was estimated in 25 hearts with chronic cor pulmonale. Also, the weight of the left ventricle, including the whole septum and the free part of the right ventricle, was determined to be 100 g. Distinct hypertrophy of the right ventricular part of the septum could be demonstrated in all cases. A weight increase of the left ventricle, including the whole septum, is frequently caused by the hypertrophic ventricular part of the septum. Th relative weight of the right ventricular portion )calculated according to Muller's method) was subtracted from the weight of the left ventricle plus the whole septum. After this weight correction, a hypertropyh of the left ventricle could only be demonstrated in cases with hypertension or renal arterio= and arteriolosclerosis. In one case of left ventricular hypertrophy, hypertension could not be ruled out. In most of the cases a distinct dilation of the left ventricle could be found. The highest degrees of dilation were found in patients with brohchiectases of the lungs. Our results indicate that the structural dialation of the left ventricle may be due to an increased shunt-volume by bronchopulmonary anastomoses.
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Abstract
In an attempt to clarify the relationship between left ventricular function and chronic obstructive pulmonary disease (COPD), systolic time intervals (STI) were measured in 12 control subjects and 28 patients with COPD who had only moderate arterial blood gas abnormalities and who had no cardiac symptomatology or clinical evidence of organic heart disease. The patients with COPD were divided into three groups of increasingly severe airway obstruction based on the percent predicted forced expired volume in one second.
Significant differences in pre-ejection period index (PEP
1
) and left ventricular ejection time index (LVET
1
) existed between the control subjects and the patients with the most severe lung disease (Group III). A highly significant difference in PEP/LVET existed between these two groups. The abnormalities of STI demonstrated in these patients are characteristic of left ventricular dysfunction and indicate that subclinical left ventricular dysfunction is frequently present in patients with moderate obstructive lung disease.
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Malovany RJ, Koerner SK. Acute respiratory insufficiency and cor pulmonale. Pathophysiology, clinical features, and management. II. Management. Am Heart J 1974; 88:251-5. [PMID: 4152189 DOI: 10.1016/0002-8703(74)90017-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Koerner SK, Malovany RJ. Acute respiratory insufficiency and cor pulmonale: Pathophysiology, clinical features and management. Am Heart J 1974; 88:115-9. [PMID: 4601127 DOI: 10.1016/0002-8703(74)90357-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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36
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Weisse AB. Contralateral effects of cardiac disease affecting primarily either the left or right chambers of the heart. Am Heart J 1974; 87:654-60. [PMID: 4274227 DOI: 10.1016/0002-8703(74)90506-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mason DT. Regulation of cardiac performance in clinical heart disease. Interactions between contractile state mechanical abnormalities and ventricular compensatory mechanisms. Am J Cardiol 1973; 32:437-48. [PMID: 4273893 DOI: 10.1016/s0002-9149(73)80034-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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38
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39
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Frank MJ, Weisse AB, Moschos CB, Levinson GE. Left ventricular function, metabolism, and blood flow in chronic cor pulmonale. Circulation 1973; 47:798-806. [PMID: 4572384 DOI: 10.1161/01.cir.47.4.798] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Left ventricular function, oxidative metabolism, and coronary blood flow were evaluated in 11 patients with chronic cor pulmonale (mean age 53 years) at rest and during stress, and compared with 11 normal subjects (mean age 29 years) studied under similar conditions. The left ventricles of patients with chronic cor pulmonale were normal in regard to contractile state, preload, afterload, coronary blood flow, and myocardial oxidative metabolism. However, the mean cardiac index, stroke volume, stroke work, and left ventricular ejection fraction were below normal, and end-systolic volume was elevated. These differences in performance are consistent with the older mean age of the patients. An alternative explanation is the limit placed on right ventricular stroke volume by the increased afterload (pulmonary vascular resistance). Allowance for these factors permits the conclusion that the left ventricles of patients with chronic cor pulmonale are normal unless involved by a second disease process.
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Burrows B, Kettel LJ, Niden AH, Rabinowitz M, Diener CF. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med 1972; 286:912-8. [PMID: 5013974 DOI: 10.1056/nejm197204272861703] [Citation(s) in RCA: 223] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Lockhart A, Nader F, Tzareva M, Schrijen F. Comparative effects of exercise and isocapnic voluntary hyperventilation on pulmonary haemodynamics in chronic bronchitis and emphysema. Eur J Clin Invest 1970; 1:69-76. [PMID: 5470479 DOI: 10.1111/j.1365-2362.1970.tb00599.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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