期刊
AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY
卷 320, 期 5, 页码 L715-L725出版社
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajplung.00583.2020
关键词
pressure-volume relationship; pulmonary arterial hypertension; right ventricle; right ventricle-pulmonary arterial; systolic function coupling
资金
- Excellence Cluster CardioPulmonary System (ECCPS)
- Collaborative Research Center (SFB) 1213 -Pulmonary Hypertension and Cor Pulmonale [SFB1213/1]
- National Heart, Lung, and Blood Institute of the National Institutes of Health [K23-HL146889, R01-HL114910]
- Jerome Greene Scholarship
The study shows that RV pressure-volume loop shape and RV systolic pressure differential are primarily determined by afterload and PAH severity, and reflect RV-arterial coupling in PAH.
Right ventricular (RV) function determines outcome in pulmonary arterial hypertension (PAH). RV pressure-volume loops, the gold standard for measuring RV function, are difficult to analyze. Our aim was to investigate whether simple assessments of RV pressure-volume loop morphology and RV systolic pressure differential reflect PAH severity and RV function. We analyzed multibeat RV pressure-volume loops (obtained by conductance catheterization with preload reduction) in 77 patients with PAH and 15 patients without pulmonary hypertension in two centers. Patients were categorized according to their pressure-volume loop shape (triangular, quadratic, trapezoid, or notched). RV systolic pressure differential was defined as end-systolic minus begin- ning-systolic pressure (ESP BSP), augmentation index as ESP BSP/pulse pressure, pulmonary arterial capacitance (PAC) as stroke volume/pulse pressure, and RV-arterial coupling as end-systolic/arterial elastance (Ees/Ea). Trapezoid and notched pressure-volume loops were associated with the highest afterload (Ea), augmentation index, pulmonary vascular resistance (PVR), mean pulmonary arterial pressure, stroke work, B-type natriuretic peptide, and the lowest Ees/Ea and PAC. Multivariate linear regression identified Ea, PVR, and stroke work as the main determinants of ESP - BSP. ESP - BSP also significantly correlated with multibeat Ees/Ea (Spearman's rho: -0.518, P < 0.001). A separate retrospective analysis of 113 patients with PAH showed that ESP - BSP obtained by routine right heart catheterization significantly correlated with a noninvasive surrogate of RV-arterial coupling (tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio; rho: 0.376, P < 0.001). In conclusion, pressure-volume loop shape and RV systolic pressure differential predominately depend on afterload and PAH severity and reflect RV-arterial coupling in PAH.
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