Document Detail

Right atrial pressure affects the interaction between lung mechanics and right ventricular function in spontaneously breathing COPD patients.
MedLine Citation:
PMID:  22272306     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure.
METHODS: Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output.
RESULTS: Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure.
CONCLUSIONS: We show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure.
Bart Boerrigter; Pia Trip; Harm Jan Bogaard; Herman Groepenhoff; Frank Oosterveer; Nico Westerhof; Anton Vonk Noordegraaf
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-01-17
Journal Detail:
Title:  PloS one     Volume:  7     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2012  
Date Detail:
Created Date:  2012-01-24     Completed Date:  2012-06-11     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e30208     Citation Subset:  IM    
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Blood Pressure
Heart Atria
Middle Aged
Pulmonary Artery / physiopathology
Pulmonary Disease, Chronic Obstructive / physiopathology*
Pulmonary Wedge Pressure / physiology*
Respiratory Function Tests
Respiratory Mechanics / physiology*
Ventricular Function, Right / physiology*

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

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