Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension
Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altere...
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| Veröffentlicht in: | American journal of physiology. Heart and circulatory physiology 2020-12, Vol.319 (6), p.H1438-H1450 |
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| creator | Fukumitsu, Masafumi Westerhof, Berend E Ruigrok, Dieuwertje Braams, Natalia J Groeneveldt, Joanne A Bayoumy, Ahmed A Marcus, J Tim Meijboom, Lilian J de Man, Frances S Westerhof, Nico Bogaard, Harm-Jan Vonk Noordegraaf, Anton |
| description | Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are as follows:
) to investigate whether reflected pressure returns sooner in proximal than in distal CTEPH and
) to elucidate whether the timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy, and wall stress. Right heart catheterization and cardiac MRI were performed in 17 patients with proximal CTEPH and 17 patients with distal CTEPH. In addition to the determination of PVR, compliance, and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as %systole). Findings were related to RV dimensions and time-resolved RV wall stress. Proximal CTEPH was characterized by higher RV volumes, mass, and wall stress, and lower RVEF. While PVR, compliance, and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53 ± 8% vs. distal 63 ± 15%,
< 0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass, and wall stress were all related to the timing of peak reflected pressure. Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance, and characteristic impedance do not explain the differences in RV function between proximal and distal CTEPH.
In chronic thromboembolic pulmonary hypertension (CTEPH), proximal localization of vessel obstructions is associated with poor right ventricular (RV) function compared with distal localization, though pulmonary vascular resistance, vascular compliance, characteristic impedance, and the magnitude of wave reflection are similar. In proximal CTEPH, the RV is exposed to an earlier return of the reflected wave. Early wave reflection may increase RV wall stress and compromise RV function. |
| doi_str_mv | 10.1152/ajpheart.00442.2020 |
| format | Article |
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) to investigate whether reflected pressure returns sooner in proximal than in distal CTEPH and
) to elucidate whether the timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy, and wall stress. Right heart catheterization and cardiac MRI were performed in 17 patients with proximal CTEPH and 17 patients with distal CTEPH. In addition to the determination of PVR, compliance, and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as %systole). Findings were related to RV dimensions and time-resolved RV wall stress. Proximal CTEPH was characterized by higher RV volumes, mass, and wall stress, and lower RVEF. While PVR, compliance, and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53 ± 8% vs. distal 63 ± 15%,
< 0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass, and wall stress were all related to the timing of peak reflected pressure. Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance, and characteristic impedance do not explain the differences in RV function between proximal and distal CTEPH.
In chronic thromboembolic pulmonary hypertension (CTEPH), proximal localization of vessel obstructions is associated with poor right ventricular (RV) function compared with distal localization, though pulmonary vascular resistance, vascular compliance, characteristic impedance, and the magnitude of wave reflection are similar. In proximal CTEPH, the RV is exposed to an earlier return of the reflected wave. Early wave reflection may increase RV wall stress and compromise RV function.</description><identifier>ISSN: 0363-6135</identifier><identifier>EISSN: 1522-1539</identifier><identifier>DOI: 10.1152/ajpheart.00442.2020</identifier><identifier>PMID: 33035435</identifier><language>eng</language><publisher>United States: American Physiological Society</publisher><subject>Aged ; Arterial Pressure ; Catheterization ; Catheterization, Swan-Ganz ; Chronic Disease ; Compliance ; Elastic waves ; Female ; Heart ; Humans ; Hypertension ; Hypertension, Pulmonary - diagnosis ; Hypertension, Pulmonary - etiology ; Hypertension, Pulmonary - physiopathology ; Hypertrophy ; Hypertrophy, Right Ventricular - diagnostic imaging ; Hypertrophy, Right Ventricular - etiology ; Hypertrophy, Right Ventricular - physiopathology ; Impedance ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Artery - physiopathology ; Pulmonary Embolism - complications ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - physiopathology ; Pulmonary hypertension ; Reflected waves ; Retrospective Studies ; Stress ; Stroke Volume ; Systole ; Thromboembolism ; Time Factors ; Vascular Resistance ; Ventricle ; Ventricular Dysfunction, Right - diagnostic imaging ; Ventricular Dysfunction, Right - etiology ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Function, Right ; Ventricular Remodeling ; Wave reflection</subject><ispartof>American journal of physiology. Heart and circulatory physiology, 2020-12, Vol.319 (6), p.H1438-H1450</ispartof><rights>Copyright American Physiological Society Dec 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-d0df1d88f1ab10530c0181523a3ed4ae3397d0b817c9d38f26d25e6ab41bd2d33</citedby><cites>FETCH-LOGICAL-c399t-d0df1d88f1ab10530c0181523a3ed4ae3397d0b817c9d38f26d25e6ab41bd2d33</cites><orcidid>0000-0002-8868-6857 ; 0000-0003-4753-2461</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3026,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33035435$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fukumitsu, Masafumi</creatorcontrib><creatorcontrib>Westerhof, Berend E</creatorcontrib><creatorcontrib>Ruigrok, Dieuwertje</creatorcontrib><creatorcontrib>Braams, Natalia J</creatorcontrib><creatorcontrib>Groeneveldt, Joanne A</creatorcontrib><creatorcontrib>Bayoumy, Ahmed A</creatorcontrib><creatorcontrib>Marcus, J Tim</creatorcontrib><creatorcontrib>Meijboom, Lilian J</creatorcontrib><creatorcontrib>de Man, Frances S</creatorcontrib><creatorcontrib>Westerhof, Nico</creatorcontrib><creatorcontrib>Bogaard, Harm-Jan</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Anton</creatorcontrib><title>Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension</title><title>American journal of physiology. Heart and circulatory physiology</title><addtitle>Am J Physiol Heart Circ Physiol</addtitle><description>Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are as follows:
) to investigate whether reflected pressure returns sooner in proximal than in distal CTEPH and
) to elucidate whether the timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy, and wall stress. Right heart catheterization and cardiac MRI were performed in 17 patients with proximal CTEPH and 17 patients with distal CTEPH. In addition to the determination of PVR, compliance, and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as %systole). Findings were related to RV dimensions and time-resolved RV wall stress. Proximal CTEPH was characterized by higher RV volumes, mass, and wall stress, and lower RVEF. While PVR, compliance, and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53 ± 8% vs. distal 63 ± 15%,
< 0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass, and wall stress were all related to the timing of peak reflected pressure. Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance, and characteristic impedance do not explain the differences in RV function between proximal and distal CTEPH.
In chronic thromboembolic pulmonary hypertension (CTEPH), proximal localization of vessel obstructions is associated with poor right ventricular (RV) function compared with distal localization, though pulmonary vascular resistance, vascular compliance, characteristic impedance, and the magnitude of wave reflection are similar. In proximal CTEPH, the RV is exposed to an earlier return of the reflected wave. Early wave reflection may increase RV wall stress and compromise RV function.</description><subject>Aged</subject><subject>Arterial Pressure</subject><subject>Catheterization</subject><subject>Catheterization, Swan-Ganz</subject><subject>Chronic Disease</subject><subject>Compliance</subject><subject>Elastic waves</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Hypertension, Pulmonary - etiology</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Hypertrophy</subject><subject>Hypertrophy, Right Ventricular - diagnostic imaging</subject><subject>Hypertrophy, Right Ventricular - etiology</subject><subject>Hypertrophy, Right Ventricular - physiopathology</subject><subject>Impedance</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Pulmonary hypertension</subject><subject>Reflected waves</subject><subject>Retrospective Studies</subject><subject>Stress</subject><subject>Stroke Volume</subject><subject>Systole</subject><subject>Thromboembolism</subject><subject>Time Factors</subject><subject>Vascular Resistance</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Right - diagnostic imaging</subject><subject>Ventricular Dysfunction, Right - etiology</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><subject>Ventricular Function, Right</subject><subject>Ventricular Remodeling</subject><subject>Wave reflection</subject><issn>0363-6135</issn><issn>1522-1539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQQC0EokvhFyAhS1y4ZBl77HwcUVWgUiUucI4ce8Jm5cTBdgr77_HSlkMP1ozlNyPPPMbeCtgLoeVHc1wPZGLeAygl9xIkPGO78iIrobF7znaANVa1QH3BXqV0BADd1PiSXSACaoV6x_5cm-hPPFLe4sLDWLLRk83k-G9zR4lPi41kUsni9POQ-R0tOU528yYWwnuecqR05rg9xLBMlucS5yFQOb5c183PYTHxxA-nlWKmJU1hec1ejMYnevMQL9mPz9ffr75Wt9--3Fx9uq0sdl2uHLhRuLYdhRkEaAQLoi0zokFyyhBi1zgYWtHYzmE7ytpJTbUZlBicdIiX7MN93zWGXxul3M9TsuS9WShsqZdKdZ2utYaCvn-CHkPZSvldoRqo67ZRqlB4T9kYUirr6tc4zWW8XkB_FtM_iun_ienPYkrVu4fe2zCT-1_zaAL_AicjjiA</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Fukumitsu, Masafumi</creator><creator>Westerhof, Berend E</creator><creator>Ruigrok, Dieuwertje</creator><creator>Braams, Natalia J</creator><creator>Groeneveldt, Joanne A</creator><creator>Bayoumy, Ahmed A</creator><creator>Marcus, J Tim</creator><creator>Meijboom, Lilian J</creator><creator>de Man, Frances S</creator><creator>Westerhof, Nico</creator><creator>Bogaard, Harm-Jan</creator><creator>Vonk Noordegraaf, Anton</creator><general>American Physiological Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TS</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8868-6857</orcidid><orcidid>https://orcid.org/0000-0003-4753-2461</orcidid></search><sort><creationdate>20201201</creationdate><title>Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension</title><author>Fukumitsu, Masafumi ; Westerhof, Berend E ; Ruigrok, Dieuwertje ; Braams, Natalia J ; Groeneveldt, Joanne A ; Bayoumy, Ahmed A ; Marcus, J Tim ; Meijboom, Lilian J ; de Man, Frances S ; Westerhof, Nico ; Bogaard, Harm-Jan ; Vonk Noordegraaf, Anton</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-d0df1d88f1ab10530c0181523a3ed4ae3397d0b817c9d38f26d25e6ab41bd2d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Arterial Pressure</topic><topic>Catheterization</topic><topic>Catheterization, Swan-Ganz</topic><topic>Chronic Disease</topic><topic>Compliance</topic><topic>Elastic waves</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Hypertension, Pulmonary - etiology</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Hypertrophy</topic><topic>Hypertrophy, Right Ventricular - diagnostic imaging</topic><topic>Hypertrophy, Right Ventricular - etiology</topic><topic>Hypertrophy, Right Ventricular - physiopathology</topic><topic>Impedance</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Pulmonary hypertension</topic><topic>Reflected waves</topic><topic>Retrospective Studies</topic><topic>Stress</topic><topic>Stroke Volume</topic><topic>Systole</topic><topic>Thromboembolism</topic><topic>Time Factors</topic><topic>Vascular Resistance</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Right - diagnostic imaging</topic><topic>Ventricular Dysfunction, Right - etiology</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><topic>Ventricular Function, Right</topic><topic>Ventricular Remodeling</topic><topic>Wave reflection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fukumitsu, Masafumi</creatorcontrib><creatorcontrib>Westerhof, Berend E</creatorcontrib><creatorcontrib>Ruigrok, Dieuwertje</creatorcontrib><creatorcontrib>Braams, Natalia J</creatorcontrib><creatorcontrib>Groeneveldt, Joanne A</creatorcontrib><creatorcontrib>Bayoumy, Ahmed A</creatorcontrib><creatorcontrib>Marcus, J Tim</creatorcontrib><creatorcontrib>Meijboom, Lilian J</creatorcontrib><creatorcontrib>de Man, Frances S</creatorcontrib><creatorcontrib>Westerhof, Nico</creatorcontrib><creatorcontrib>Bogaard, Harm-Jan</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Anton</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of physiology. Heart and circulatory physiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fukumitsu, Masafumi</au><au>Westerhof, Berend E</au><au>Ruigrok, Dieuwertje</au><au>Braams, Natalia J</au><au>Groeneveldt, Joanne A</au><au>Bayoumy, Ahmed A</au><au>Marcus, J Tim</au><au>Meijboom, Lilian J</au><au>de Man, Frances S</au><au>Westerhof, Nico</au><au>Bogaard, Harm-Jan</au><au>Vonk Noordegraaf, Anton</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension</atitle><jtitle>American journal of physiology. Heart and circulatory physiology</jtitle><addtitle>Am J Physiol Heart Circ Physiol</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>319</volume><issue>6</issue><spage>H1438</spage><epage>H1450</epage><pages>H1438-H1450</pages><issn>0363-6135</issn><eissn>1522-1539</eissn><abstract>Pulmonary vascular resistance (PVR) and compliance are comparable in proximal and distal chronic thromboembolic pulmonary hypertension (CTEPH). However, proximal CTEPH is associated with inferior right ventricular (RV) adaptation. Early wave reflection in proximal CTEPH may be responsible for altered RV function. The aims of the study are as follows:
) to investigate whether reflected pressure returns sooner in proximal than in distal CTEPH and
) to elucidate whether the timing of reflected pressure is related to RV dimensions, ejection fraction (RVEF), hypertrophy, and wall stress. Right heart catheterization and cardiac MRI were performed in 17 patients with proximal CTEPH and 17 patients with distal CTEPH. In addition to the determination of PVR, compliance, and characteristic impedance, wave separation analysis was performed to determine the magnitude and timing of the peak reflected pressure (as %systole). Findings were related to RV dimensions and time-resolved RV wall stress. Proximal CTEPH was characterized by higher RV volumes, mass, and wall stress, and lower RVEF. While PVR, compliance, and characteristic impedance were similar, proximal CTEPH was related to an earlier return of reflected pressure than distal CTEPH (proximal 53 ± 8% vs. distal 63 ± 15%,
< 0.05). The magnitude of the reflected pressure waves did not differ. RV volumes, RVEF, RV mass, and wall stress were all related to the timing of peak reflected pressure. Poor RV function in patients with proximal CTEPH is related to an early return of reflected pressure wave. PVR, compliance, and characteristic impedance do not explain the differences in RV function between proximal and distal CTEPH.
In chronic thromboembolic pulmonary hypertension (CTEPH), proximal localization of vessel obstructions is associated with poor right ventricular (RV) function compared with distal localization, though pulmonary vascular resistance, vascular compliance, characteristic impedance, and the magnitude of wave reflection are similar. In proximal CTEPH, the RV is exposed to an earlier return of the reflected wave. Early wave reflection may increase RV wall stress and compromise RV function.</abstract><cop>United States</cop><pub>American Physiological Society</pub><pmid>33035435</pmid><doi>10.1152/ajpheart.00442.2020</doi><orcidid>https://orcid.org/0000-0002-8868-6857</orcidid><orcidid>https://orcid.org/0000-0003-4753-2461</orcidid></addata></record> |
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| ispartof | American journal of physiology. Heart and circulatory physiology, 2020-12, Vol.319 (6), p.H1438-H1450 |
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| subjects | Aged Arterial Pressure Catheterization Catheterization, Swan-Ganz Chronic Disease Compliance Elastic waves Female Heart Humans Hypertension Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - etiology Hypertension, Pulmonary - physiopathology Hypertrophy Hypertrophy, Right Ventricular - diagnostic imaging Hypertrophy, Right Ventricular - etiology Hypertrophy, Right Ventricular - physiopathology Impedance Magnetic Resonance Imaging Male Middle Aged Pulmonary Artery - physiopathology Pulmonary Embolism - complications Pulmonary Embolism - diagnosis Pulmonary Embolism - physiopathology Pulmonary hypertension Reflected waves Retrospective Studies Stress Stroke Volume Systole Thromboembolism Time Factors Vascular Resistance Ventricle Ventricular Dysfunction, Right - diagnostic imaging Ventricular Dysfunction, Right - etiology Ventricular Dysfunction, Right - physiopathology Ventricular Function, Right Ventricular Remodeling Wave reflection |
| title | Early return of reflected waves increases right ventricular wall stress in chronic thromboembolic pulmonary hypertension |
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