Clinical Patho-physiological Study on Effects of Pulmonary Arterial Pressure Decrease upon Ejection Time and Mechanical Effects of the Right Ventricle : Part II. The Change of Mechanical Effects of the Right Ventricle During Ejection Time

AbstractObjectiveTo evaluate echocardiographically the function and morphology of the right heart subsequent to transcatheter closure of atrial septal defects.MethodsWe performed echocardiographic studies in 73 patients undergoing transcatheter closure of atrial septal defects 1 day prior to closure, and then 3 days and 3 months after closure. We calculated the antero-posterior diameter of the right ventricle, the transverse diameter and length of the right atrium, the pulmonary arterial pressure, and the velocities of systolic movement and early and late diastolic movement of the basal parietal walls of the right ventricle.ResultsThe atrial septal defects varied in size between 8 and 33 millimetres, and were closed using occluders measuring from 10 to 40 millimetres. At 3 days after closure, the antero-posterior diameter of the right ventricle, the transverse diameter and length of the right atrium, the pulmonary arterial pressure, and the velocities of mural motion were all significantly decreased. After 3 months, the size of the right heart had more or less normalized.ConclusionsTranscatheter closure of atrial septal defects produces marked improvement in the function and geometry of the chambers of the right heart, reducing pulmonary arterial pressure as well as abolishing the interatrial shunt.

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Prognostic value of the right ventricle diameter, pulmonary arterial pressure and biomarkers in patients with acute heart failure

Acta Facultatis Medicae Naissensis ◽

10.5937/afmnai38-28538 ◽

2021 ◽

Vol 38 (2) ◽

pp. 116-124

Author(s):

Dejan Petrović ◽

Marina Deljanin-Ilić ◽

Sanja Stojanović ◽

Dejan Simonović ◽

Dijana Stojanović ◽

...

Keyword(s):

Heart Failure ◽

Arterial Pressure ◽

Right Ventricle ◽

Right Ventricular ◽

Acute Heart Failure ◽

Pulmonary Arterial Pressure ◽

Prognostic Significance ◽

Pulmonary Arterial ◽

One Year ◽

The Right

The aim of the paper was to examine the echocardiographic parameters of the right ventricle (RV), its diameter and pulmonary arterial pressure (PAP); to determine their relationship to B-type natriuretic peptide (BNP), troponin and (TnI) and high-sensititity C-raective protein (hsCRP), and to evaluate their prognostic significance to one-year mortality in patients with acute heart failure (AHF). The study included a total of 225 patients (pts) (70.29 ± 9.74 years) who were admitted to Intensive care unit due to the signs and symptoms of AHF. The values of standard biochemical parameters, BNP, TnI and hsCRP were determined during the first 24 hours after admission. All patients underwent echocardiographic examination. During a one-year follow-up, 78 (34.70%) patients died. As compared with the group of survivors (n = 147), the group of non-survivors had higher values of BNP (853.10 ± 384.92 vs. 1399.68 ± 464.44 pg/mL, p < 0.001), TnI (0.59 ± 2.04 vs. 2.00 ± 8.29 ng/ml, p < 0.05), right ventricular diameter and PAP (p < 0.001). BNP was positively correlated with TnI (r = 0.311), PAP (r = 0.255) and right ventricular diameter (r = 0.304, p < 0.001 for all correlations). The cut-off value of BNP ≥ 1062.04 pg/ml, PAP ≥ 44.5 mmHg and TnI ≥ 0.04 ng/ml were associated with a higher risk of mortality. Our results have shown that BNP, PAP and TnI are strong and independent predictors of one-year mortality in hospitalized patients with acute heart failure.

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Telemetry monitoring of pulmonary arterial pressure in freely moving rats

Journal of Applied Physiology ◽

10.1152/jappl.1996.81.2.1027 ◽

1996 ◽

Vol 81 (2) ◽

pp. 1027-1032 ◽

Cited By ~ 56

Author(s):

P. Hess ◽

M. Clozel ◽

J. P. Clozel

Keyword(s):

Pulmonary Hypertension ◽

Arterial Pressure ◽

Right Ventricle ◽

Pulmonary Arterial Pressure ◽

Telemetry System ◽

Mean Pulmonary Arterial Pressure ◽

Freely Moving Rats ◽

Pulmonary Arterial ◽

Freely Moving ◽

The Right

Several rat models of pulmonary hypertension have been developed. However, up until now it has been difficult to monitor pulmonary arterial pressure for long periods of time. The goal of the present study was to develop a telemetry system allowing chronic monitoring of pulmonary arterial pressure in freely moving rats. For this purpose, while animals were under anesthesia, a sensing catheter was implanted into the pulmonary arterial trunk through the right ventricle. This catheter was connected to an emitter implanted in the abdomen. Validation of the system was performed in three steps. First, acutely, we controlled that the pressure signal transmitted by the telemetry system was accurate and corresponded to a signal obtained with a high-fidelity Millar catheter. Second, we evaluated the chronic consequences of implantation of the system. Third, we used the system to monitor pulmonary arterial pressure in a model of monocrotaline-induced hypertension in which the effects of bosentan, an endothelin-receptor antagonist, were evaluated. The telemetry system was reliable and did not lead to damage of the right ventricle and/or to chronic pulmonary embolism. After a recovery period of 8–10 days, mean pulmonary arterial pressure was stable. With the use of this telemetry system, it was possible to follow the increase of pulmonary arterial pressure induced by monocrotaline. In this model, bosentan decreased mean pulmonary arterial pressure by 13% (P = 0.07), suggesting a role of endothelin in this model of pulmonary hypertension. We conclude that it is possible to use this telemetry system to monitor pulmonary arterial pressure in freely moving conscious rats.

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Chronic lung lymph fistula that only drains the left lung

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1995.269.4.r943 ◽

1995 ◽

Vol 269 (4) ◽

pp. R943-R947

Author(s):

Y. Kikuchi ◽

H. Nakazawa ◽

D. L. Traber

Keyword(s):

Arterial Pressure ◽

Pulmonary Arterial Pressure ◽

Mediastinal Lymph Node ◽

Pulmonary Veins ◽

Pulmonary Arteries ◽

Left Lung ◽

Lymph Flow ◽

Pulmonary Arterial ◽

The Right ◽

Arteries And Veins

We developed a chronic lung fistula that drains only the left lung, allowing for evaluation of injury in a single lung. To remove lymph drainage from the right lung into the caudal mediastinal lymph node, the right lower pulmonary ligament was severed. Pneumatic occluders were placed on the left pulmonary arteries and veins. To ensure that lymph drained from only the left lung, we increased the right pulmonary arterial pressure (RPAP) from 21.2 +/- 0.5 to 36.5 +/- 0.6 mmHg. The left pulmonary arterial pressure (LPAP) was kept at wedge pressure level for 1 h by inflating pneumatic occluders. Lymph flow from the left lung fistula was stable during this occlusion. Six hours after recovery was increased the LPAP from a baseline level of 19.1 +/- 1.0 to 36.4 +/- 0.9 mmHg and the RPAP from 21.2 +/- 0.5 to 38.0 +/- 0.8 mmHg for 2 h by inflating the pneumatic occluders on the left and right pulmonary veins. Lymph flow increased from 5.3 +/- 1.0 to 28.0 +/- 2.9 ml/h. Reflection coefficient was calculated at 0.80 +/- 0.02.

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Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients

Experimental Biology and Medicine ◽

10.1177/1535370218775321 ◽

2018 ◽

Vol 243 (9) ◽

pp. 754-761

Author(s):

Jie Liu ◽

Lei Fei ◽

Guang-Qing Huang ◽

Xiao-Ke Shang ◽

Mei Liu ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Myocardial Perfusion ◽

Arterial Pressure ◽

Right Ventricle ◽

Arterial Hypertension ◽

Pulmonary Arterial Pressure ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Mean Pulmonary Arterial Pressure ◽

Pulmonary Arterial

Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients’ long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients. Furthermore, myocardial perfusion imaging was not observed in the normal subjects but in pulmonary arterial hypertension patients, especially severe pulmonary arterial hypertension subgroup, and showed potential diagnostic properties for pulmonary arterial hypertension. In conclusion, mean pulmonary arterial pressure levels are correlated with several right heart catheterization and echocardiography markers in pulmonary arterial hypertension patients; echocardiography and 99mTc myocardial perfusion can be used to evaluate right ventricle performance in pulmonary arterial hypertension patients. Impact statement In this study, we analyzed the clinical parameters for evaluating RV function, including right ventricle catheterization (RHC), echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging (MPI) in normal Asian subjects and PAH patients ( n = 23 for each group). Our results demonstrated that six RHC indexes, four echocardiography indexes and MPI index were significantly altered in PAH patients and correlated with the levels of mean pulmonary arterial pressure. Importantly, we evaluated the diagnostic performance of MPI and found that MPI has a strong diagnostic accuracy in PAH patients. The findings from this study will be of interest to clinical investigators who make diagnosis and therapeutic strategies for PAH patients.

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Hyperuricemia in patients with pulmonary hypertension: A study in a tertiary care center

IP Indian Journal of Immunology and Respiratory Medicine ◽

10.18231/j.ijirm.2021.038 ◽

2021 ◽

Vol 6 (3) ◽

pp. 173-177

Author(s):

C H Raju ◽

M Ravindranath

Keyword(s):

Pulmonary Hypertension ◽

Uric Acid ◽

Arterial Pressure ◽

Serum Uric Acid ◽

Pulmonary Arterial Pressure ◽

Nyha Class ◽

High Serum ◽

Mean Pulmonary Arterial Pressure ◽

Pulmonary Arterial ◽

The Right

Pulmonary Hypertension is one of a life-threatening disease with high rate of patient mortality. Decreased cardiac output and tissue hypoxia is measured using Uric acid as a marker for assessment of pulmonary hypertension. 75 patients who were diagnosed with a mean pulmonary arterial pressure of >22mmHg were categorized as group A and 75 healthy patients were considered to be Group B. Blood was collected for Uric acid, creatinine and total Bilirubin estimation. Pulmonary arterial systolic pressure as well as the ventricular function of the patients was evaluated using Colour Doppler ECG and a value of ≥50 mmHg, or a mean pulmonary arterial pressure (at rest) of ≥25 mmHg was taken and the right arterial pressure was calculated. Using the Simpson’s formula, the right and left ventricular ejaculation factors (RVEF, LVEF) were calculated. The serum uric acid levels among the patients were 8.3±1.4mg/dL, creatinine levels were 2.1 ± 0.5 mg/dL, and the total bilirubin levels were 1.9 ± 0.8 mg/dL all of which was significantly higher than the controls. The uric acid levels were also positively correlated to the NHYA class. The blood pressure and the pulmonary arterial pressure were also higher than that of the controls. The correlation was done between the elevated uric acid and ejection fractions and the correlation coefficients of MPAP, LVEF, RVEF and the NYHA class were all significantly associated and the values were 0.394, -0.513, -0.467 and 0.38 respectively. High serum uric acid levels is significantly associated with higher blood pressure, pulmonary arterial pressure and NYHA class. High serum uric acid levels can be a reliable prognostic marker for the detection of pulmonary hypertension. Early therapy may help in the reduction of mortality rate.

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Distribution of lung vascular resistance after chronic systemic-to-pulmonary shunts

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1985.249.6.h1106 ◽

1985 ◽

Vol 249 (6) ◽

pp. H1106-H1113 ◽

Cited By ~ 1

Author(s):

R. P. Michel ◽

T. S. Hakim ◽

R. E. Hanson ◽

A. R. Dobell ◽

F. Keith ◽

...

Keyword(s):

Arterial Pressure ◽

Vascular Resistance ◽

Pulmonary Circulation ◽

Pulmonary Arterial Pressure ◽

Lower Lobe ◽

Venous Occlusion ◽

Morphometric Measurements ◽

Arterial Resistance ◽

Pulmonary Arterial ◽

The Right

Congenital cardiac shunts produce pathological lesions on the arterial side of the lung vasculature. We examined the effects of chronic shunts (14.2 +/- 1.2 mo) in 10 young dogs, between the left subclavian and the left lower lobe (LLL) artery, on pulmonary vascular pressure and flow (P-Q) relationships, segmental resistance with arterial and venous occlusion (AVO), and sensitivity to drugs. At final thoracotomy, mean LLL pulmonary arterial pressure (Ppa) was 23.2 +/- 4.3 mmHg compared with 11.9 +/- 0.9 in the right lung (P less than 0.05); two animals had LLL Ppa of 41 and 48 mmHg. The LLL artery and vein were cannulated, and pressure-flow (P-Q) and AVO measurements were made and compared with previous control LLL (n = 11) and contralateral right lower lobe (RLL, n = 5). Responses to serotonin, histamine, and vasodilators (diltiazem and isoproterenol) were evaluated. Comparisons of morphometric measurements were made between LLL and RLL. We found a significant increase in arterial resistance as measured with AVO and a hypersensitivity to serotonin in the shunt LLL, without changes in total pulmonary vascular resistance or P-Q measurements; vasodilators had a small effect only in the hypertensive lobes. Our data suggest that chronic shunts to the pulmonary circulation increase arterial resistance and sensitivity to serotonin, even in the absence of discernible morphometric changes, and that vasoconstriction may be an important precursor to the development of morphological lesions.

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