Document Detail


Longitudinal shortening accounts for the majority of right ventricular contraction and improves after pulmonary vasodilator therapy in normal subjects and patients with pulmonary arterial hypertension.
MedLine Citation:
PMID:  21106653     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The right ventricle has a unique contraction pattern, with a greater portion of the shortening occurring in the longitudinal plane. However, the relative contributions of longitudinal and transverse shortening to overall right ventricular (RV) function have not been quantified. We sought to quantify the proportions of longitudinal and transverse shortening to RV function in normal subjects and in patients with pulmonary arterial hypertension (PAH) at baseline and following PAH-specific therapy.
METHODS: The normal cohort comprised 90 subjects with normal clinical echocardiograms, whereas the PAH cohort included 36 patients, of whom 25 had echocardiograms before and after initiation of PAH-specific therapy. Assessment of RV function included tricuspid annular plane systolic excursion, RV fractional area change (RVFAC), and relative change in RV area in longitudinal and transverse planes.
RESULTS: Longitudinal fractional area change (LFAC) accounted for the majority of total RVFAC (77% ± 14%) in normal subjects. Among patients with PAH, longitudinal shortening still represented the majority of RVFAC, even though it was less than in normal subjects (63% ± 18%, P < .0001). Following PAH therapy, overall RV function improved (RVFAC, 30% ± 13% to 36% ± 9%; P = .026), solely because of an increase in longitudinal area change. As a result, the proportion of longitudinal shortening increased (LFAC, 58% ± 18% to 69% ± 17%; P = .002), whereas transverse shortening fell (transverse fractional area change, 42% ± 18% vs 31% ± 17%; P = .002).
CONCLUSIONS: Longitudinal shortening accounts for the majority of RV contraction in normal subjects and patients with PAH, although less so in PAH. Improved RV function following pulmonary vasodilator therapy occurs solely from improvements in longitudinal contraction, suggesting that longitudinal shortening may represent the afterload-responsive element of RV functional recovery.
Authors:
Suzanne B Brown; Amresh Raina; David Katz; Molly Szerlip; Susan E Wiegers; Paul R Forfia
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-11-24
Journal Detail:
Title:  Chest     Volume:  140     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-06     Completed Date:  2011-09-01     Revised Date:  2011-09-16    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Echocardiography
Electrocardiography
Female
Follow-Up Studies
Humans
Hypertension, Pulmonary / diagnosis,  drug therapy,  physiopathology
Male
Middle Aged
Myocardial Contraction / drug effects
Retrospective Studies
Time Factors
Treatment Outcome
Vasodilator Agents / therapeutic use*
Ventricular Function, Right / drug effects*
Chemical
Reg. No./Substance:
0/Vasodilator Agents
Comments/Corrections
Comment In:
Chest. 2011 Aug;140(2):556-7; author reply 557-8   [PMID:  21813538 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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