| Right ventricular diastolic dysfunction and the acute effects of sildenafil in pulmonary hypertension patients. | |
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MedLine Citation:
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PMID: 17625080 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: This study investigated whether right ventricular (RV) diastolic function is impaired in pulmonary hypertension (PH) patients, and whether it is related to RV mass and afterload. In addition, the effects of an acute reduction of RV afterload by the oral intake of sildenafil were studied. Finally, we assessed whether diastolic function is related to cardiac parameters of disease severity. METHODS AND RESULTS: Twenty-five PH patients and 11 control subjects were studied. Right-heart catheterization and N-terminal pro-brain natriuretic peptide (NT-proBNP) sampling were performed in patients. MRI measured RV ejection fraction, mass, and diastolic function. Isovolumic relaxation time (IVRT), normalized early peak filling rate (E), atrium-induced peak filling rate (A), and E/A ratio described diastolic function. Compared to control subjects, patients had prolonged mean (+/- SD) IVRT (133.5 +/- 53.2 vs 29.3 +/- 20.8 ms, respectively; p < 0.001), decreased E (3.0 +/- 1.6 vs 6.4 +/- 2.5 s(-1), respectively; p < 0.001) and E/A ratio (1.1 +/- 0.7 vs 5.3 +/- 4.9, respectively; p < 0.001), and increased A (3.0 +/- 1.4 vs 1.5 +/- 0.9 s(-1), respectively; p = 0.001). IVRT was related to RV mass (r(25) = 0.56; p = 0.005) and pulmonary vascular resistance (r(25) = 0.74; p < 0.0001). Sildenafil therapy reduced RV afterload and improved RV diastolic and systolic function. IVRT was correlated with NT-proBNP level (r = 0.70; p < 0.001), and was inversely related to cardiac index (r = -0.70; p < 0.001) and RV ejection fraction (r = -0.69; p < 0.001). CONCLUSION: In PH patients, RV diastolic dysfunction is related to RV mass and afterload. RV diastolic function improves by reducing afterload. The correlations between diastolic function and prognostic parameters showed that diastolic function is most impaired in patients with severe disease. |
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Authors:
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C Tji-Joong Gan; Sebastiaan Holverda; J Tim Marcus; Walter J Paulus; Koen M Marques; Jean G F Bronzwaer; Jos W Twisk; Anco Boonstra; Pieter E Postmus; Anton Vonk-Noordegraaf |
Publication Detail:
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Type: Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: Chest Volume: 132 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-07-12 Completed Date: 2007-08-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 11-7 Citation Subset: AIM; IM |
Affiliation:
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VU University Medical Center, De Boelelaan 1117 PO Box 7057, 1007 MB Amsterdam, the Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antihypertensive Agents / therapeutic use Blood Circulation / physiology Blood Pressure / physiology Epoprostenol / therapeutic use Female Heart Ventricles / pathology, physiopathology Humans Hypertension, Pulmonary / drug therapy*, physiopathology Magnetic Resonance Imaging Male Middle Aged Nitric Oxide / therapeutic use Piperazines / therapeutic use* Purines / therapeutic use Severity of Illness Index Stroke Volume / physiology Sulfonamides / therapeutic use Sulfones / therapeutic use* Vascular Resistance / physiology Vasodilator Agents / therapeutic use* Ventricular Dysfunction, Right / physiopathology* |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Piperazines; 0/Purines; 0/Sulfonamides; 0/Sulfones; 0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 139755-83-2/sildenafil; 147536-97-8/bosentan; 35121-78-9/Epoprostenol |
| Comments/Corrections | |
Comment In:
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Chest. 2007 Jul;132(1):2-5
[PMID:
17625076
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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