Document Detail

Right Ventricular Dysfunction in Chronic Thromboembolic Obstruction of the Pulmonary Artery.
MedLine Citation:
PMID:  24356516     Owner:  NLM     Status:  Publisher    
Introduction: Pressure volume loops describe dynamic ventricular performance, relevant to patients with and at risk of pulmonary hypertension. We used conductance catheter-derived pressure volume loops to measure RV mechanics in patients with chronic thromboembolic pulmonary arterial obstruction at different stages of pathological adaptation. Materials and Methods: Resting conductance catheterization was performed in twenty-four patients;10 with chronic thromboembolic pulmonary hypertension(CTEPH), 7 with chronic thromboembolic disease without pulmonary hypertension(CTED) and 7 controls. To assess the validity of conductance measurements, RV volumes were compared in a subset of 8 patients with contemporaneous cardiac magnetic resonance (CMR). Results: Control, CTED and CTEPH groups showed different pressure volume loop morphology, most notable during systolic ejection. Prolonged diastolic relaxation was seen in patients with CTED and CTEPH (Tau=56.2±6.7 (Controls) vs 69.7±10.0 (CTED) vs 67.9±6.2ms (CTEPH), p=0.02). Control and CTED groups had lower afterload (Ea) and contractility (Ees) compared to the CTEPH group (Ea=0.30±0.10 vs 0.52±0.24 vs 1.92±0.70mmHg/ml respectively, p<0.001), (Ees=0.44±0.20 vs 0.59±0.15 vs 1.13±0.43mmHg/ml, p<0.01) with more efficient ventriculo-arterial coupling (Ees/Ea=0.46±0.30 vs 1.27±0.36 vs 0.60±0.18 respectively, p<0.001). Stroke volume assessed by CMR and conductance showed closest agreement (mean bias +9ml, 95%CI -1 to +19ml) compared with end-diastolic volume (+48ml, -16 to 111ml) and end-systolic volume (+37ml,-21 to 94 ml). Conclusions: RV conductance catheterization detects novel alteration in pressure volume loop morphology and delayed RV relaxation in CTED which distinguish this group from controls. The observed agreement in stroke volume assessed by CMR and conductance suggest RV mechanics are usefully measured by conductance catheter in chronic thromboembolic obstruction.
Colm McCabe; Paul A White; Stephen P Hoole; Richard G Axell; Andrew N Priest; Deepa Gopalan; Dolores Taboada; Robert V Mackenzie Ross; Nicholas W Morrell; Leonard M Shapiro; Joanna Pepke-Zaba
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-19
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  -     ISSN:  1522-1601     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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