期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 186, 期 2, 页码 181-189出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201110-1860OC
关键词
diastolic dysfunction; pulmonary arterial hypertension; pressure-volume relationship; diastolic ventricular interaction
资金
- Deutsche Forschungsgesellschaft [DFG: SFB/TR 19, B5, A2]
- EC, FP7-Health-2010, MEDIA [261409]
- Deutsches Zentrum fur Herz-Kreislauf-Forschung (DZHK)
Rationale: Severe increase in right ventricular pressure can compromise left ventricular (LV) function because of impaired interventricular interaction and aggravate the symptoms. Objectives: To elucidate how nonsevere idiopathic pulmonary arterial hypertension (IPAH) influences LV function because of impaired interventricular interaction. Methods: Invasive pressure-volume (PV) loop analysis obtained by conductance catheterization was performed at rest and during atrial pacing in patients with mild IPAH (n = 10) compared with patients with isolated LV diastolic dysfunction (DD) (n = 10) and control subjects without heart failure symptoms (n = 9). Measurements and Main Results: Patients with nonsevere IPAH (pulmonary artery pressure mean 29 +/- 5 mm Hg) and patients with DD showed preserved systolic (ejection fraction 63 +/- 12% and 62 +/- 9%) and impaired LV diastolic function at rest (LV stiffness 0.027 +/- 0.012 ml(-1) and 0.029 +/- 0.014 ml(-1)). During pacing at 120 per minute patients with IPAH and DD decreased their stroke volume (-25% and -30%; P < 0.05) and failed to increase cardiac output significantly. Opposite to patients with DD and control subjects, temporary preload reduction during inferior vena cava occlusion initially induced an expansion of LV end-diastolic volume in IPAH (+7%; P < 0.05), whereas end-diastolic pressure continuously dropped. This resulted in an initial downward shift to the right of the PV loop indicating better LV filling, which was associated with a temporary improvement of cardiac output (+11%; P < 0.05) in the patients with IPAH, but not in patients with DD and control subjects. Conclusions: Mild idiopathic pulmonary arterial pressure impairs LV diastolic compliance even in the absence of the intrinsic LV disease and contributes to the reduced cardiac performance at stress.
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