Document Detail

Right ventricular failure in idiopathic pulmonary arterial hypertension is associated with inefficient myocardial oxygen utilization.
MedLine Citation:
PMID:  21900188     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In idiopathic pulmonary arterial hypertension (IPAH), increased right ventricular (RV) power is required to maintain cardiac output. For this, RV O2 consumption (MVO2) must increase by augmentation of O2 supply and/or improvement of mechanical efficiency-ratio of power output to MVO2. In IPAH with overt RV failure, however, there is evidence that O2 supply (perfusion) reserve is reduced, leaving only increase in either O2 extraction or mechanical efficiency as compensatory mechanisms. We related RV mechanical efficiency to clinical and hemodynamic parameters of RV function in patients with IPAH and associated it with glucose metabolism.
METHODS AND RESULTS: The patients included were in New York Heart Association (NYHA) class II (n=8) and class III (n=8). They underwent right heart catheterization, MRI, and H2(15)O-, (15)O2-, C(15)O-, and 18FDG-PET. RV power and O2 supply were similar in both groups (NYHA class II versus class III: 0.54±0.14 versus 0.47±0.12 J/s and 0.109±0.022 versus 0.128±0.026 mL O2/min per gram, respectively). RV O2 extraction was near-significantly lower in NYHA class II compared with NYHA class III (63±17% versus 75±16%, respectively, P=0.10). As a result, MVO2 was significantly lower (0.066±0.012 versus 0.092±0.010 mL O2/min per gram, respectively, P=0.006). RV efficiency was reduced in NYHA class III (13.9±3.8%) compared with NYHA class II (27.8±7.6%, P=0.001). Septal bowing, measured by MRI, correlated with RV efficiency (r = -0.59, P=0.020). No relation was found between RV efficiency and glucose uptake rate. RV mechanical efficiency and ejection fraction were closely related (r=0.81, P<0.001).
CONCLUSIONS: RV failure in IPAH was associated with reduced mechanical efficiency that was partially explained by RV mechanical dysfunction but not by a metabolic shift.
Yeun Ying Wong; Gerrina Ruiter; Mark Lubberink; Pieter G Raijmakers; Paul Knaapen; J Tim Marcus; Anco Boonstra; Adriaan A Lammertsma; Nico Westerhof; Willem J van der Laarse; Anton Vonk-Noordegraaf
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-09-07
Journal Detail:
Title:  Circulation. Heart failure     Volume:  4     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-17     Completed Date:  2012-01-11     Revised Date:  2012-05-24    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  700-6     Citation Subset:  IM    
Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Cardiac Output / physiology
Glucose / metabolism
Heart Catheterization
Heart Ventricles / physiopathology*
Hypertension, Pulmonary / classification,  epidemiology*,  metabolism*
Magnetic Resonance Imaging
Middle Aged
Myocardium / metabolism*
New York
Oxygen / metabolism*
Positron-Emission Tomography
Severity of Illness Index
Stroke Volume / physiology
Ventricular Dysfunction, Right / classification,  epidemiology*,  metabolism*
Reg. No./Substance:
50-99-7/Glucose; 7782-44-7/Oxygen

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

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