Skip to main content

19.05.2016 | Original Article | Ausgabe 8/2016

European Journal of Applied Physiology 8/2016

Arterial-ventricular and interventricular interaction in isolated post-capillary and combined pulmonary hypertension in severe mitral stenosis

European Journal of Applied Physiology > Ausgabe 8/2016
Ashwin Venkateshvaran, Srikanth Sola, Satish Chandra Govind, Pravat Kumar Dash, Sagar Vyavahare, Lars H. Lund, Bé la Merkely, Anikó Ilona Nagy, Aristomenis Manouras
Wichtige Hinweise
Communicated by Keith Phillip George.

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00421-016-3393-z) contains supplementary material, which is available to authorized users.
A. I. Nagy and A. Manouras contributed equally to this work.



Isolated post-capillary pulmonary hypertension (Ipc-PH) is characterized by elevated left atrial pressures that are passively transmitted upstream, whereas combined pre- and post-capillary PH (Cpc-PH) demonstrates additional reactive changes in pulmonary vasculature. The increased load imposed on the right ventricle (RV) influences left ventricular (LV) mechanics by means of interventricular interaction. However, there is lack of evidence to substantiate the effect of possible additional alterations in the arterio-ventricular (AV) coupling and their effect on LV function. Considering the discrepant RV load in Cpc-PH and Ipc-PH, we sought to investigate whether these two conditions are also characterized by differential alterations in AV coupling.

Methods and results

Invasive hemodynamic and echocardiographic data of 120 patients with PH due to severe rheumatic mitral stenosis before and immediately after percutaneous valvulotomy, along with 40 age-matched healthy controls, were analyzed. Effective arterial (E a) and ventricular elastance (E es) were measured. PH patients demonstrated elevated LV afterload (E a) along with AV uncoupling, and these derangements were more evident in the Cpc-PH group [E a: 3.3 (2.3–5.4) vs 2.6 (2.1–3.5) mmHg/mL, E a/E es: 0.73 (0.6–0.9) vs 0.88 (0.7–1.2), p < 0.05]. In addition, PH was associated with reduced LV deformation, which was mainly determined by elevated E a, while the effect of interventricular interaction was limited to the septal wall.


Our results suggest that in addition to the interventricular interaction, an abnormal AV coupling contributes to the altered LV mechanics that has been associated with adverse prognosis in Cpc-PH.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf

Weitere Produktempfehlungen anzeigen
Nur für berechtigte Nutzer zugänglich
Über diesen Artikel

Weitere Artikel der Ausgabe 8/2016

European Journal of Applied Physiology 8/2016 Zur Ausgabe
  1. Sie können e.Med Allgemeinmedizin 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

Neu im Fachgebiet Arbeitsmedizin