Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Herz
Erschienen in: Herz 6/2019

17.05.2019 | Main topic

Right ventricular function in pulmonary (arterial) hypertension

verfasst von: Dr. K. Tello, H. Gall, M. Richter, A. Ghofrani, R. Schermuly

Erschienen in: Herz | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

The right ventricle (RV) is the main determinant of prognosis in pulmonary hypertension. Adaptation and maladaptation of the RV are of crucial importance. In the course of disease, RV contractility increases through changes in muscle properties and muscle hypertrophy. At a certain point, the point of “uncoupling,” the afterload exceeds contractility, and maladaptation as well as dilation occurs to maintain stroke volume (SV). To understand the adaptational processes and to further develop targeted medication directly affecting load-independent contractility, an accurate and precise assessment of contractility and RV–pulmonary artery (PA) coupling should be performed. In this review, we shed light on existing methods to assess RV function, including the gold standard measurement of contractility and RV–PA coupling, and we evaluate existing surrogates of RV–PA coupling.
Literatur
1.
Andersen S, Nielsen-Kudsk JE, Vonk Noordegraaf A et al (2019) Right ventricular fibrosis. Circulation 139:269–285CrossRefPubMed
2.
Axell RG, Messer SJ, White PA et al (2017) Ventriculo-arterial coupling detects occult RV dysfunction in chronic thromboembolic pulmonary vascular disease. Physiol Rep 5(7):e13227CrossRefPubMedPubMedCentral
3.
4.
Badagliacca R, Poscia R, Pezzuto B et al (2015) Right ventricular remodeling in idiopathic pulmonary arterial hypertension: Adaptive versus maladaptive morphology. J Heart Lung Transplant 34:395–403CrossRefPubMed
5.
Baggen VJ, Leiner T, Post MC et al (2016) Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: A systematic review and meta-analysis. Eur Radiol 26:3771–3780CrossRefPubMedPubMedCentral
6.
Bosch L, Lam CSP, Gong L et al (2017) Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction. Eur J Heart Fail 19:1664–1671CrossRefPubMed
7.
Brewis MJ, Bellofiore A, Vanderpool RR et al (2016) Imaging right ventricular function to predict outcome in pulmonary arterial hypertension. Int J Cardiol 218:206–211CrossRefPubMedPubMedCentral
8.
Brimioulle S, Wauthy P, Ewalenko P et al (2003) Single-beat estimation of right ventricular end-systolic pressure-volume relationship. Am J Physiol Heart Circ Physiol 284:H1625–H1630CrossRefPubMed
9.
Claessen G, La Gerche A, Voigt JU et al (2016) Accuracy of echocardiography to evaluate pulmonary vascular and RV function during exercise. JACC Cardiovasc Imaging 9:532–543CrossRefPubMed
10.
De Tombe PP, Jones S, Burkhoff D et al (1993) Ventricular stroke work and efficiency both remain nearly optimal despite altered vascular loading. Am J Physiol 264:H1817–H1824PubMed
11.
Dickstein ML, Yano O, Spotnitz HM et al (1995) Assessment of right ventricular contractile state with the conductance catheter technique in the pig. Cardiovasc Res 29:820–826CrossRefPubMed
12.
Forfia PR, Fisher MR, Mathai SC et al (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174:1034–1041CrossRefPubMed
13.
Fourie PR, Coetzee AR, Bolliger CT (1992) Pulmonary artery compliance: Its role in right ventricular-arterial coupling. Cardiovasc Res 26:839–844CrossRefPubMed
14.
Freed BH, Gomberg-Maitland M, Chandra S et al (2012) Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. J Cardiovasc Magn Reson 14:11CrossRefPubMedPubMedCentral
15.
16.
Galie N, Hoeper MM, Humbert M et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263CrossRefPubMed
17.
García-Álvarez A, García-Lunar I, Pereda D et al (2015) Association of myocardial T1-mapping CMR with hemodynamics and RV performance in pulmonary hypertension. JACC Cardiovasc Imaging 8:76–82CrossRefPubMed
18.
Gerges M, Gerges C, Pistritto AM et al (2015) Pulmonary hypertension in heart failure. Epidemiology, right ventricular function, and survival. Am J Respir Crit Care Med 192:1234–1246CrossRefPubMed
19.
Ghuysen A, Lambermont B, Kolh P et al (2008) Alteration of right ventricular-pulmonary vascular coupling in a porcine model of progressive pressure overloading. Shock 29:197–204PubMed
20.
Gorter TM, van Veldhuisen DJ, Voors AA et al (2018) Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension. Eur Heart J Cardiovasc Imaging 19:425–432CrossRefPubMed
21.
Grapsa J, Gibbs JS, Cabrita IZ et al (2012) The association of clinical outcome with right atrial and ventricular remodelling in patients with pulmonary arterial hypertension: Study with real-time three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 13:666–672CrossRefPubMed
22.
23.
Grewal J, Majdalany D, Syed I et al (2010) Three-dimensional echocardiographic assessment of right ventricular volume and function in adult patients with congenital heart disease: Comparison with magnetic resonance imaging. J Am Soc Echocardiogr 23:127–133CrossRefPubMed
24.
Guazzi M (2018) Use of TAPSE/PASP ratio in pulmonary arterial hypertension: An easy shortcut in a congested road. Int J Cardiol 266:242–244CrossRefPubMed
25.
Guazzi M, Bandera F, Pelissero G et al (2013) Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: An index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 305:H1373–H1381CrossRef
26.
Guazzi M, Dixon D, Labate V et al (2017) RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: Stratification of clinical phenotypes and outcomes. JACC Cardiovasc Imaging 10:1211–1221CrossRef
27.
Guazzi M, Naeije R, Arena R et al (2015) Echocardiography of right Ventriculoarterial coupling combined with cardiopulmonary exercise testing to predict outcome in heart failure. Chest 148:226–234CrossRefPubMed
28.
Hsu S, Houston BA, Tampakakis E et al (2016) Right ventricular functional reserve in pulmonary arterial hypertension. Circulation 133:2413–2422CrossRefPubMedPubMedCentral
29.
Hulshof HG, Eijsvogels TMH, Kleinnibbelink G et al (2018) Prognostic value of right ventricular longitudinal strain in patients with pulmonary hypertension: A systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 20(4):475–484CrossRef
30.
Iles L, Pfluger H, Phrommintikul A et al (2008) Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol 52:1574–1580CrossRefPubMed
31.
Inuzuka R, Hsu S, Tedford RJ et al (2018) Single-beat estimation of right ventricular contractility and its coupling to pulmonary arterial load in patients with pulmonary hypertension. J Am Heart Assoc 7(10):e7929CrossRefPubMedPubMedCentral
32.
Jone PN, Schäfer M, Pan Z et al (2018) 3D echocardiographic evaluation of right ventricular function and strain: A prognostic study in paediatric pulmonary hypertension. Eur Heart J Cardiovasc Imaging 19:1026–1033CrossRefPubMed
33.
Kuehne T, Yilmaz S, Steendijk P et al (2004) Magnetic resonance imaging analysis of right ventricular pressure-volume loops: In vivo validation and clinical application in patients with pulmonary hypertension. Circulation 110:2010–2016CrossRefPubMed
34.
Lahm T, Douglas IS, Archer SL et al (2018) Assessment of right ventricular function in the research setting: Knowledge gaps and pathways forward. An official American Thoracic Society research statement. Am J Respir Crit Care Med 198:e15–e43CrossRefPubMed
35.
Lamia B, Muir JF, Molano LC et al (2017) Altered synchrony of right ventricular contraction in borderline pulmonary hypertension. Int J Cardiovasc Imaging 33(9):1331–1339CrossRefPubMed
36.
Levy PT, El Khuffash A, Woo KV et al (2018) Right ventricular-pulmonary vascular interactions: An emerging role for pulmonary artery acceleration time by echocardiography in adults and children. J Am Soc Echocardiogr 31:962–964CrossRefPubMed
37.
Maffessanti F, Muraru D, Esposito R et al (2013) Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: A multicenter echocardiographic study in 507 healthy volunteers. Circ Cardiovasc Imaging 6:700–710CrossRefPubMed
38.
Maughan WL, Shoukas AA, Sagawa K et al (1979) Instantaneous pressure-volume relationship of the canine right ventricle. Circ Res 44:309–315CrossRefPubMed
39.
McCabe C, White PA, Hoole SP et al (2014) Right ventricular dysfunction in chronic thromboembolic obstruction of the pulmonary artery: A pressure-volume study using the conductance catheter. J Appl Physiol 116:355–363CrossRefPubMed
40.
McCabe C, White PA, Rana BS et al (2014) Right ventricle functional assessment: Have new techniques supplanted the old faithful conductance catheter? Cardiol Rev 22(5):233–240CrossRefPubMed
41.
Mewton N, Liu CY, Croisille P et al (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903CrossRef
42.
Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360CrossRefPubMed
43.
Peacock AJ, Crawley S, McLure L et al (2014) Changes in right ventricular function measured by cardiac magnetic resonance imaging in patients receiving pulmonary arterial hypertension-targeted therapy: The EURO-MR study. Circ Cardiovasc Imaging 7:107–114CrossRefPubMed
44.
Pratali L, Allemann Y, Rimoldi SF et al (2013) RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: A stress echocardiographic and tissue Doppler imaging study. JACC Cardiovasc Imaging 6:1287–1297CrossRefPubMed
45.
Prins KW, Archer SL, Pritzker M et al (2018) Interleukin-6 is independently associated with right ventricular function in pulmonary arterial hypertension. J Heart Lung Transplant 37:376–384CrossRefPubMed
46.
Prins KW, Weir EK, Archer SL et al (2016) Pulmonary pulse wave transit time is associated with right ventricular-pulmonary artery coupling in pulmonary arterial hypertension. Pulm Circ 6:576–585CrossRefPubMedPubMedCentral
47.
Rain S, Handoko ML, Trip P et al (2013) Right ventricular diastolic impairment in patients with pulmonary arterial hypertension. Circulation 128:2016–2025CrossRefPubMed
48.
Redington AN, Gray HH, Hodson ME et al (1988) Characterisation of the normal right ventricular pressure-volume relation by biplane angiography and simultaneous micromanometer pressure measurements. Br Heart J 59:23–30CrossRefPubMedPubMedCentral
49.
Rex S, Missant C, Claus P et al (2008) Effects of inhaled iloprost on right ventricular contractility, right ventriculo-vascular coupling and ventricular interdependence: A randomized placebo-controlled trial in an experimental model of acute pulmonary hypertension. Crit Care (Lond) 12:R113CrossRef
50.
Richter MJ, Ghofrani HA, Gall H (2018) Beyond interleukin-6 in right ventricular function: Evidence for another biomarker. J Heart Lung Transplant 37:674–675CrossRefPubMed
51.
Sanz J, García-Alvarez A, Fernández-Friera L et al (2012) Right ventriculo-arterial coupling in pulmonary hypertension: A magnetic resonance study. Heart 98:238–243CrossRefPubMed
52.
53.
Shehata ML, Lossnitzer D, Skrok J et al (2011) Myocardial delayed enhancement in pulmonary hypertension: Pulmonary hemodynamics, right ventricular function, and remodeling. AJR Am J Roentgenol 196:87–94CrossRefPubMedPubMedCentral
54.
Spruijt OA, De Man FS, Groepenhoff H et al (2015) The effects of exercise on right ventricular contractility and right ventricular-arterial coupling in pulmonary hypertension. Am J Respir Crit Care Med 191:1050–1057CrossRefPubMed
55.
Suga H, Sagawa K, Shoukas AA (1973) Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 32:314–322CrossRefPubMed
56.
Swift AJ, Capener D, Johns C et al (2017) Magnetic resonance imaging in the prognostic evaluation of patients with pulmonary arterial hypertension. Am J Respir Crit Care Med 196(2):228–239CrossRefPubMedPubMedCentral
57.
Tedford RJ, Mudd JO, Girgis RE et al (2013) Right ventricular dysfunction in systemic sclerosis-associated pulmonary arterial hypertension. Circ Heart Fail 6:953–963CrossRefPubMed
58.
Tello K, Axmann J, Ghofrani HA et al (2018) Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension. Int J Cardiol 266:229–235CrossRefPubMed
59.
Tello K, Dalmer A, Axmann J et al (2019) Reserve of right ventricular-arterial coupling in the setting of chronic overload. Circ Heart Fail 12:e5512CrossRefPubMed
60.
61.
62.
Tello K, Richter MJ, Axmann J et al (2018) More on single-beat estimation of right ventriculoarterial coupling in pulmonary arterial hypertension. Am J Respir Crit Care Med 198:816–818CrossRefPubMed
63.
Trip P, Kind T, van de Veerdonk MC et al (2013) Accurate assessment of load-independent right ventricular systolic function in patients with pulmonary hypertension. J Heart Lung Transplant 32:50–55CrossRefPubMed
64.
Trip P, Rain S, Handoko ML et al (2015) Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension. Eur Respir J 45:1603–1612CrossRefPubMed
65.
66.
van de Veerdonk MC, Kind T, Marcus JT et al (2011) Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 58:2511–2519CrossRefPubMed
67.
van de Veerdonk MC, Marcus JT, Westerhof N et al (2015) Signs of right ventricular deterioration in clinically stable patients with pulmonary arterial hypertension. Chest 147:1063–1071CrossRefPubMed
68.
69.
Vanderpool RR, Pinsky MR, Naeije R et al (2015) RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart 101:37–43CrossRefPubMed
70.
Vanderpool RR, Rischard F, Naeije R et al (2016) Simple functional imaging of the right ventricle in pulmonary hypertension: Can right ventricular ejection fraction be improved? Int J Cardiol 223:93–94CrossRefPubMedPubMedCentral
71.
Vogel M, Schmidt MR, Kristiansen SB et al (2002) Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: Comparison with ventricular pressure-volume relations in an animal model. Circulation 105:1693–1699CrossRefPubMed
72.
73.
Vonk Noordegraaf A, Westerhof BE, Westerhof N (2017) The relationship between the right ventricle and its load in pulmonary hypertension. J Am Coll Cardiol 69:236–243CrossRefPubMed
74.
Wang J, Prakasa K, Bomma C et al (2007) Comparison of novel echocardiographic parameters of right ventricular function with ejection fraction by cardiac magnetic resonance. J Am Soc Echocardiogr 20:1058–1064CrossRef
75.
Wang Z, Yuan LJ, Cao TS et al (2013) Simultaneous beat-by-beat investigation of the effects of the Valsalva maneuver on left and right ventricular filling and the possible mechanism. PLoS ONE 8:e53917CrossRefPubMedPubMedCentral
Metadaten
Titel
Right ventricular function in pulmonary (arterial) hypertension
verfasst von
Dr. K. Tello
H. Gall
M. Richter
A. Ghofrani
R. Schermuly
Publikationsdatum
17.05.2019
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 6/2019
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-019-4815-6

Weitere Artikel der Ausgabe 6/2019

Herz 6/2019 Zur Ausgabe

CME

CME: Medizinische Versorgung von Erwachsenen mit angeborenen Herzfehlern

Review articles

Cardiovascular outcome in type 2 diabetes and atrial fibrillation

Original articles

Intermuscular implantation technique for subcutaneous cardioverter-defibrillators

Original articles

Cognitive performance of patients with chronic heart failure on sacubitril/valsartan

Originalarbeiten

Schwerwiegende unerwünschte Ereignisse in klinischen Prüfungen mit TAVR und SAVR

Main topic

COPD and heart failure: differential diagnosis and comorbidity

Neu im Fachgebiet Kardiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise