Document Detail

LV Dysfunction Induced by a Non-severe Idiopathic Pulmonary Arterial Hypertension. A Pressure-Volume Relationship Study.
MedLine Citation:
PMID:  22561959     Owner:  NLM     Status:  Publisher    
RATIONALE: Severe increase in right ventricular pressure can compromise left-ventricular function due to impaired interventricular interaction and aggravate the symptoms. OBJECTIVE: To elucidate how already mild/moderate idiopathic pulmonary arterial hypertension (IPAH) contributes to left-ventricular dysfunction due to impaired interventricular interaction. METHODS: Invasive pressure-volume (PV) loop analysis obtained by conductance catheterization was performed at rest and during atrial pacing in patients with mild IPAH (n=10) in comparison to the patients with isolated LV diastolic dysfunction (DD) (n=10) and controls without heart failure symptoms (n=9). MEASUREMENTS AND MAIN RESULTS: Mild IPAH (41±13mmHg) and DD patients showed preserved systolic (EF 63 ±12% and 62 ±9%) and impaired LV diastolic function at rest (LV stiffness 0.027±0.012 ml-1 and 0.029±0.014 ml-1). During pacing at 120/min IPAH and DD patients decreased their SV (-25% and -30%, p<0.05) and failed to increase cardiac output significantly. Opposite to DD and controls, temporary preload reduction during inferior vena cava occlusion initially induced an expansion of LV end-diastolic volume in IPAH (+7%, p<0.05), whereas end-diastolic pressure continuously dropped. This resulted in an initial downward shift to the right of the PV loop indicating better LV filling which was associated with a temporary improvement of cardiac output (+11%, p<0.05) in the IPAH, but not in DD and controls. CONCLUSION: Idiopathic pulmonary arterial pressure impairs LV diastolic function even in the absence of the intrinsic LV disease and contributes to the reduced cardiac performance at stress.
Mario Kasner; Dirk Westermann; Paul Steendijk; Stephan Dröse; Wolfgang Poller; Heinz-Peter Schultheiss; Carsten Tschöpe
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-3
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Cardiology and pneumology, Charite - University Medicine Berlin CBF, Berlin, Germany.
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