Journalartikel

Jahr der Veröffentlichung: 2021

Seiten: L715-L725

Zeitschrift: American Journal of Physiology - Lung Cellular and Molecular Physiology

Bandnummer: 320

Heftnummer: 5

ISSN: 1040-0605

eISSN: 1522-1504

Open Access Status: Green

DOI Link: https://doi.org/10.1152/ajplung.00583.2020

Verlag: American Physiological Society

Abstract: 
Right ventricular (RV) function determines outcome in pulmonary arterial hypertension (PAH). RV pressure-volume loops, the gold standard for measuring RV function, are difficult to analyze. Our aim was to investigate whether simple assessments of RV pressure-volume loop morphology and RV systolic pressure differential reflect PAH severity and RV function. We analyzed multibeat RV pressure-volume loops (obtained by conductance catheterization with preload reduction) in 77 patients with PAH and 15 patients without pulmonary hypertension in two centers. Patients were categorized according to their pressure-volume loop shape (triangular, quadratic, trapezoid, or notched). RV systolic pressure differential was defined as end-systolic minus begin- ning-systolic pressure (ESP BSP), augmentation index as ESP BSP/pulse pressure, pulmonary arterial capacitance (PAC) as stroke volume/pulse pressure, and RV-arterial coupling as end-systolic/arterial elastance (Ees/Ea). Trapezoid and notched pressure-volume loops were associated with the highest afterload (Ea), augmentation index, pulmonary vascular resistance (PVR), mean pulmonary arterial pressure, stroke work, B-type natriuretic peptide, and the lowest Ees/Ea and PAC. Multivariate linear regression identified Ea, PVR, and stroke work as the main determinants of ESP - BSP. ESP - BSP also significantly correlated with multibeat Ees/Ea (Spearman's rho: -0.518, P < 0.001). A separate retrospective analysis of 113 patients with PAH showed that ESP - BSP obtained by routine right heart catheterization significantly correlated with a noninvasive surrogate of RV-arterial coupling (tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio; rho: 0.376, P < 0.001). In conclusion, pressure-volume loop shape and RV systolic pressure differential predominately depend on afterload and PAH severity and reflect RV-arterial coupling in PAH.

Harvard-Zitierstil: Richter, M., Hsu, S., Yogeswaran, A., Husain-Syed, F., Vadasz, I., Ghofrani, H., et al. (2021) Right ventricular pressure-volume loop shape and systolic pressure change in pulmonary hypertension, American Journal of Physiology - Lung Cellular and Molecular Physiology, 320(5), pp. L715-L725. https://doi.org/10.1152/ajplung.00583.2020

APA-Zitierstil: Richter, M., Hsu, S., Yogeswaran, A., Husain-Syed, F., Vadasz, I., Ghofrani, H., Naeije, R., Harth, S., Grimminger, F., Seeger, W., Gall, H., Tedford, R., & Tello, K. (2021). Right ventricular pressure-volume loop shape and systolic pressure change in pulmonary hypertension. American Journal of Physiology - Lung Cellular and Molecular Physiology. 320(5), L715-L725. https://doi.org/10.1152/ajplung.00583.2020