Document Detail


Right ventricular afterload and the role of nitric oxide metabolism in left-sided heart failure.
MedLine Citation:
PMID:  24125109     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Awareness has grown in recent years that right ventricular (RV) function is equally important as left ventricular (LV) function in the setting of left-sided heart disease. RV dysfunction can be the consequence of an increased afterload imposed by the failing LV. The concept of "afterload" is physically most correctly described by vascular input impedance. However, for clinical purposes, afterload is most often modeled to consist of 3 components; pulmonary vascular resistance (PVR), pulmonary arterial compliance (PAC), and characteristic impedance. Whereas PVR is historically most described, PAC (which represents the distensibility of the vasculature) has rapidly gained recognition for its prognostic ability in both pulmonary arterial hypertension and left-sided heart disease. Owing to the specific anatomy of the pulmonary circulation, PVR and PAC have an inverse hyperbolic relationship, which position can be shifted by varying wedge pressures. Knowledge of the afterload components helps one to understand how elevated left-sided filling pressures increase pulsatile load on the RV. An increase in resistive load (known as "reactive" or "out-of-proportion" pulmonary hypertension) ultimately complements the increase in pulsatile load. Perturbations in nitric oxide metabolism are thought to be crucial in this evolution and have therefore been sought as a major therapeutic target.
Authors:
Matthias Dupont; W H Wilson Tang
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2013-09-05
Journal Detail:
Title:  Journal of cardiac failure     Volume:  19     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-15     Completed Date:  2014-05-26     Revised Date:  2014-10-09    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  712-21     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Heart Failure / diagnosis,  metabolism,  physiopathology*
Humans
Nitric Oxide / metabolism,  physiology*
Pulmonary Wedge Pressure / physiology
Vascular Resistance / physiology*
Ventricular Dysfunction, Right / diagnosis,  metabolism,  physiopathology*
Grant Support
ID/Acronym/Agency:
P20 HL113452/HL/NHLBI NIH HHS; P20HL113452/HL/NHLBI NIH HHS; R01 HL103931/HL/NHLBI NIH HHS; R01 HL115008/HL/NHLBI NIH HHS; R01HL103931/HL/NHLBI NIH HHS; R01HL115008/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
31C4KY9ESH/Nitric Oxide
Comments/Corrections

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