| Pulmonary Capillary Wedge Pressure Augments Right Ventricular Pulsatile Loading. | |
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MedLine Citation:
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PMID: 22131357 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: -Right ventricular (RV) failure from increased pulmonary vascular loading is a major cause of morbidity and mortality, yet its modulation by disease remains poorly understood. We tested the hypotheses that, unlike the systemic circulation, pulmonary vascular resistance (R(PA)) and compliance (C(PA)) are consistently and inversely related regardless of age, pulmonary hypertension (PH), or interstitial fibrosis, and that this relation may be changed by elevated pulmonary capillary wedge pressure (PCWP), augmenting RV pulsatile load. METHODS AND RESULTS: -Several large clinical databases with right heart/pulmonary catheterization data were analyzed to determine the R(PA)-C(PA) relationship with PH, pulmonary fibrosis, patient age, and varying PCWP. Patients with suspected or documented PH (n=1009) and normal PCWP displayed a consistent R(PA)-C(PA) hyperbolic (inverse) dependence; C(PA)=0.564/(0.047+R(PA)), with a near constant resistance-compliance product (RC) (0.48±0.17 seconds). In the same patients, the systemic RC was highly variable. Severe pulmonary fibrosis (n=89) did not change the R(PA)-C(PA) relation. Increasing patient age led to a very small though statistically significant change in the relation. However, elevation of the PCWP (n=8142) had a larger impact, significantly lowering C(PA) for any R(PA), and negatively correlating RC (p<0.0001). CONCLUSIONS: -PH and pulmonary fibrosis do not significantly change the hyperbolic dependence between R(PA) and C(PA), while patient age has only minimal affects. This fixed relationship helps explain the difficulty of reducing total RV afterload by therapies that have modest impact on mean R(PA). Higher PCWP appears to enhance net RV afterload by elevating pulsatile, relative to resistive load, and may contribute to RV dysfunction. |
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Authors:
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Ryan J Tedford; Paul M Hassoun; Stephen C Mathai; Reda E Girgis; Stuart D Russell; David R Thiemann; Oscar H Cingolani; James O Mudd; Barry A Borlaug; Margaret M Redfield; David J Lederer; David A Kass |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-30 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-12-1 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 Johns Hopkins Medical Institutions, Baltimore, MD; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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