HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (39) Citing Articles via Google Scholar Google Scholar Articles by Marcus, J. T. Articles by Boonstra, A. Search for Related Content PubMed PubMed Citation Articles by Marcus, J. T. Articles by Boonstra, A.

Impaired Left Ventricular Filling Due to Right Ventricular Pressure Overload in Primary Pulmonary Hypertension^*

Noninvasive Monitoring Using MRI

^* From the Departments of Clinical Physics and Informatics (Drs. Marcus and Heethaar), Pulmonary Medicine (Drs. Vonk Noordegraaf, Roeleveld, Postmus, and Boonstra), and Cardiology (Dr. Van Rossum), ICaR-VU, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.

Correspondence to: J. Tim Marcus, PhD, Department of Clinical Physics and Informatics, University Hospital, Vrije Universiteit, PO Box 7057, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands; e-mail: jt.marcus{at}azvu.nl

Objective: To analyze the effect of primary pulmonary hypertension (PPH) on cardiac function using MRI.

Methods: In 12 patients (9 women; age range, 30 to 56 years), the diagnosis of PPH had been established by catheterization (mean ± SD pulmonary artery pressure [PAP] was 56 ± 8 mm Hg). With breath-hold cine MRI, a series of short-axis images was acquired covering the whole left ventricle (LV) and right ventricle (RV). The curvature, defined as 1 divided by the radius of curvature in centimeters, was calculated for the septum and the LV free wall in early diastole. Leftward ventricular septal bowing (LVSB) is denoted by a negative curvature. For the LV and the RV, the end-diastolic volume (EDV), stroke volume (SV), and volumetric filling rate were calculated. The control subjects were all healthy (n = 14; 11 women; age range, 20 to 57 years).

Results: In the patients, LVSB was quantified in early diastole by the septal curvature of - 0.14 ± 0.07 cm^-1, and the septal to free-wall curvature ratio of - 0.42 ± 0.21. LV EDV and LV SV correlated negatively with diastolic PAP (p = 0.004 and p = 0.04, respectively). In patients vs control subjects, RV SV was reduced (52 ± 12 mL vs 82 ± 11 mL, p < 0.0001); LV peak filling rate was smaller (2.2 ± 0.7 EDV/s vs 3.3 ± 0.5 EDV/s, p < 0.001); LV EDV was smaller (81 ± 23 mL vs 117 ± 19 mL, p = 0.001); and LV SV was smaller (49 ± 18 mL vs 83 ± 13 mL, p < 0.0001).

Conclusion: In PPH, RV pressure overload leads to LVSB and reduced RV output. By decreased blood delivery, LV filling is reduced, which results in decreased LV SV by the Frank-Starling mechanism.

Key Words: diastole • heart failure • hypertension • pulmonary • pulmonary heart disease • ventricles

This article has been cited by other articles:

				A. Y. Denault, Y. Lamarche, P. Couture, F. Haddad, J. Lambert, J.-C. Tardif, and L. P. Perrault Inhaled milrinone: a new alternative in cardiac surgery? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2006; 10(4): 346 - 360. [Abstract] [PDF]

				M. B. Pitton, G. Kemmerich, S. Herber, E. Mayer, M. Thelen, and C. Duber Hemodynamic effects of monomeric nonionic contrast media in pulmonary angiography in chronic thromboembolic pulmonary hypertension. Am. J. Roentgenol., July 1, 2006; 187(1): 128 - 134. [Abstract] [Full Text] [PDF]

				C. Tji-Joong Gan, J.-W. Lankhaar, J. T. Marcus, N. Westerhof, K. M. Marques, J. G. F. Bronzwaer, A. Boonstra, P. E. Postmus, and A. Vonk-Noordegraaf Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension Am J Physiol Heart Circ Physiol, April 1, 2006; 290(4): H1528 - H1533. [Abstract] [Full Text] [PDF]

				A. Vonk-Noordegraaf, J. T. Marcus, C. T. Gan, A. Boonstra, and P. E. Postmus Interventricular Mechanical Asynchrony Due To Right Ventricular Pressure Overload in Pulmonary Hypertension Plays an Important Role in Impaired Left Ventricular Filling Chest, December 1, 2005; 128(6_suppl): 628S - 630S. [Full Text] [PDF]

				K. G. Blyth, B. A. Groenning, T. N. Martin, J. E. Foster, P. B. Mark, H. J. Dargie, and A. J. Peacock Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension Eur. Heart J., October 1, 2005; 26(19): 1993 - 1999. [Abstract] [Full Text] [PDF]

				S. L. Merklinger, R. A. Wagner, E. Spiekerkoetter, A. Hinek, R. H. Knutsen, M. G. Kabir, K. Desai, S. Hacker, L. Wang, G. M. Cann, et al. Increased Fibulin-5 and Elastin in S100A4/Mts1 Mice With Pulmonary Hypertension Circ. Res., September 16, 2005; 97(6): 596 - 604. [Abstract] [Full Text] [PDF]

				R. J. Roeleveld, J. T. Marcus, T. J. C. Faes, T.-J. Gan, A. Boonstra, P. E. Postmus, and A. Vonk-Noordegraaf Interventricular Septal Configuration at MR Imaging and Pulmonary Arterial Pressure in Pulmonary Hypertension Radiology, March 1, 2005; 234(3): 710 - 717. [Abstract] [Full Text] [PDF]

				R. Kluge, H. Barthel, H. Pankau, A. Seese, J. Schauer, H. Wirtz, H.-J. Seyfarth, J. Steinbach, O. Sabri, and J. Winkler Different Mechanisms for Changes in Glucose Uptake of the Right and Left Ventricular Myocardium in Pulmonary Hypertension J. Nucl. Med., January 1, 2005; 46(1): 25 - 31. [Abstract] [Full Text] [PDF]

				C. Reboul, S. Tanguy, J. M. Juan, M. Dauzat, and P. Obert Cardiac remodeling and functional adaptations consecutive to altitude training in rats: implications for sea level aerobic performance J Appl Physiol, January 1, 2005; 98(1): 83 - 92. [Abstract] [Full Text] [PDF]

				T. Kuehne, S. Yilmaz, P. Steendijk, P. Moore, M. Groenink, M. Saaed, O. Weber, C. B. Higgins, P. Ewert, E. Fleck, et al. Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops: In Vivo Validation and Clinical Application in Patients With Pulmonary Hypertension Circulation, October 5, 2004; 110(14): 2010 - 2016. [Abstract] [Full Text] [PDF]

				J.-W. Lankhaar, A. V. Noordegraaf, J. T. Marcus, E. Laffon, C. Vallet, V. Bernard, M. Montaudon, D. Ducassou, F. Laurent, and R. Marthan A computed method for noninvasive MRI assessment of pulmonary arterial hypertension J Appl Physiol, August 1, 2004; 97(2): 794 - 795. [Full Text] [PDF]

				R. J. Roeleveld, A. Vonk-Noordegraaf, J. T. Marcus, J. G. F. Bronzwaer, K. M. J. Marques, P. E. Postmus, and A. Boonstra Effects of Epoprostenol on Right Ventricular Hypertrophy and Dilatation in Pulmonary Hypertension Chest, February 1, 2004; 125(2): 572 - 579. [Abstract] [Full Text] [PDF]

				R. M. Setser, R. D. White, B. Sturm, P. M. McCarthy, R. C. Starling, J. B. Young, J. Kasper, T. Buda, N. Obuchowski, and M. L. Lieber Noninvasive assessment of cardiac mechanics and clinical outcome after partial left ventriculectomy Ann. Thorac. Surg., November 1, 2003; 76(5): 1576 - 1585. [Abstract] [Full Text] [PDF]