Journalartikel

Jahr der Veröffentlichung: 2019

Seiten: E41-E42

Zeitschrift: American Journal of Respiratory and Critical Care Medicine

Bandnummer: 199

Heftnummer: 11

ISSN: 1073-449X

eISSN: 1535-4970

DOI Link: https://doi.org/10.1164/rccm.201809-1787IM

Verlag: American Thoracic Society

Abstract: 

A 40-year-old woman with idiopathic pulmonary arterial hypertension underwent acute vasoreactivity testing with inhaled nitric oxide (10 ppm) according to current guidelines (1). As part of the Right Heart 1 study (2), she also underwent concurrent pressure-volume catheterization with preload reduction via inferior vena cava balloon occlusion and volume calibration by cardiac magnetic resonance (described previously) (3, 4). The patient showed positive acute vasoreactivity: mean pulmonary arterial pressure decreased from 40 to 23 mm Hg and cardiac output (Fick method) increased from 4.2 to 4.6 L/min. Multibeat right ventricular (RV)-arterial coupling (end-systolic/arterial elastances) significantly improved from 0.71 to 1.84 (Figure 1; values >1.5 considered optimal); end-systolic elastance remained constant and arterial elastance decreased substantially. Interestingly, a previously described single-beat method (without need for preload reduction) (4) yielded comparable results (Figure 1). RV ejection fraction increased from 36% to 48%, end-diastolic volume slightly decreased from 173 to 168 ml, and end-systolic volume substantially diminished from 107 to 89 ml.

To our knowledge, this is the first demonstration of improved RV-arterial coupling corresponding to acute vasoreactivity. The enormous improvement of RV-arterial coupling was mediated by a reduction in arterial elastance. This report is a first step in addressing the recently highlighted lack of clinical data on the response of RV-arterial coupling to drugs targeting pulmonary hypertension (5).

Harvard-Zitierstil: Tello, K., Dalmer, A., Husain-Syed, F., Seeger, W., Naeije, R., Ghofrani, H., et al. (2019) Multibeat Right Ventricular-Arterial Coupling during a Positive Acute Vasoreactivity Test, American Journal of Respiratory and Critical Care Medicine, 199(11), pp. E41-E42. https://doi.org/10.1164/rccm.201809-1787IM

APA-Zitierstil: Tello, K., Dalmer, A., Husain-Syed, F., Seeger, W., Naeije, R., Ghofrani, H., Gall, H., & Richter, M. (2019). Multibeat Right Ventricular-Arterial Coupling during a Positive Acute Vasoreactivity Test. American Journal of Respiratory and Critical Care Medicine. 199(11), E41-E42. https://doi.org/10.1164/rccm.201809-1787IM