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PubMed2001

[Determination of right ventricular ejection fraction by thermodilution catheter technique during exercise: a comparison with radionuclide ventriculography].

Since the development of a Swan-Ganz Thermodilution Ejection Fraction Catheter, several studies have been published which compare this technique for obtaining right ventricular ejection fraction (RVEFTD) with alternative methods. However, the reliability of RVEFTD measurements under exercise conditions remains undetermined. Therefore, the aim of the present study was to evaluate RVEFTD with the Gated Blood Pool method (RVEFGBP) under exercise conditions. Twenty patients with different cardiac diseases (coronary artery disease, valvular incompetence, cardiomyopathy) underwent right heart catheterization, including RVEFTD and simultaneous RVEFGBP determination at rest and during supine bicycle exercise. Cardiac index at rest-/exercise was 2.9 +/- 0.8/5.7 +/- 2.2 l/min/m2, mean pulmonary artery pressure was 15 +/- 5/25 +/- 8 mmHg, RVEFTD was 38 +/- 6/41 +/- 11% and RVEFRNV was 39 +/- 6/43 +/- 8%. Linear regression analysis showed a significant correlation between RVEFTD and RVEFGBP at rest (r = 0.72, p < or = 0.0005) and during exercise (r = 0.72, p < or = 0.0005). It is concluded that the Thermodilution Ejection Fraction Catheter is a useful device for reliable, repetitive and safe RVEF measurements, not only at rest but also under exercise conditions. This is clinically important, because RVEF, as a sensitive parameter of primary or secondary right ventricular dysfunction, can be determined in the course of standard right heart catheterization.

Adult↗
PubMed1985

Effect of long-term administration of digoxin on exercise performance in chronic airflow obstruction.

We have studied the effect of long-term digoxin on exercise performance in 15 patients with pulmonary heart disease due to severe chronic airflow obstruction (FEV1/VC ratio 29 +/- 6%: mean +/- SD). Digoxin (0.25 mg/day) was given for 8 weeks in a randomized, double-blind crossover, placebo-controlled trial. All patients were ambulatory and had clinical features of right ventricular dysfunction but no clinical evidence of left ventricular dysfunction. Assessments included progressive and steady-state exercise, pulmonary function studies and evaluation of right and left ventricular function. In all patients the right ventricular ejection fraction was reduced; in 4 patients the left ventricular ejection fraction was also reduced. In patients whose left ventricular ejection fraction was initially abnormal, 8 weeks of digoxin increased left ventricular ejection fraction to normal. In spite of the improvement in resting ventricular function, exercise performance, the cardiopulmonary response to exercise, pulmonary function and general health status did not improve. We conclude that in patients with pulmonary heart disease: 1) digoxin improves ventricular function only if left ventricular function is reduced, and 2) despite the improvement in ventricular function digoxin does not improve pulmonary function, cardiopulmonary response to exercise or general feeling of well being.

Aged↗
PubMed1996

Variability of right ventricular functional recovery after lung transplantation.

BACKGROUND: The purpose of this study was to assess by echocardiography the effects of lung transplantation on recovery of right ventricular (RV) function in patients with preoperative RV dysfunction. METHODS: Fourteen (20%) of 71 lung transplant recipients were identified by echocardiography as manifesting abnormal RV function before lung transplantation. These 14 patients were selected for follow-up echocardiographic study 8 months after transplantation. RESULTS: RV function improved significantly in the study group. Mean RV end-diastolic area decreased from 26.8 +/- 7.9 cm2 to 20.1 +/- 4.7 cm2 (P < 0.01); mean RV end-systolic area decreased from 21.5 +/- 6.8 cm2 to 13.1 +/- 4.2 (P < 0.01); and mean RV fractional area change (FAC) increased from 20.4 +/- 3.3% to 35.8 +/- 8.9% (P < 0.001). A subgroup of four patients, however, exhibited no change in RV function. Patients who achieved improvement in RV function tended to be younger, had shorter duration of disease before transplantation, and had higher pulmonary arterial (PA) pressures before transplantation (PA systolic, 89 +/- 28 mmHg vs. 38 +/- 11 mmHg, P < 0.001; PA diastolic, 42 +/- 11 mmHg vs. 19 +/- 3 mmHg, P < 0.002). Each of the eight patients with primary pulmonary hypertension exhibited improvement in RV function (mean delta FAC +20.6 +/- 5.9%), while two of three patients with emphysema and both patients with idiopathic pulmonary fibrosis failed to achieve improvement in RV function (mean delta FAC +2.3 +/- 1.2%). CONCLUSIONS: Improvement of RV function assessed by echocardiography occurs after lung transplantation, even in patients with severe preoperative RV dysfunction. However, the degree of improvement is variable and may depend on the degree of RV after-load reduction and the presence or absence of intrinsic myocardial disease. RV ejection parameters do not distinguish between these two possibilities.

Adolescent↗
PubMed1988

Factors affecting biventricular function following surgical repair of tetralogy of Fallot.

Right and left ventricular functions were assessed in children following surgical repair of tetralogy of Fallot. The results were analyzed with regard to the relative contribution of preoperative, perioperative and postoperative factors to postoperative functional abnormalities. Pulmonary regurgination of our Grade 3 or more depressed right and left ventricular ejection fractions and enlarged right ventricular end-diastolic volume. Right and left ventricular ejection fractions in patients with residual right ventricular outflow pressure gradients over 30 mmHg were significantly lower than those in patients with pressure gradients of 30 mmHg or less. The majority of those pressure gradients were at the pulmonary annulus or central pulmonary artery. Right and left ventricular ejection fractions were significantly lower in patients with a preoperative aortic oxygen saturation of less than 80% than in patients with one of 80% or more. The 3 variables of pulmonary regurgitation, residual pulmonary stenosis, preoperative aortic oxygen saturation were statistically independent. Left ventricular ejection fraction and end-diastolic volume correlated with the right ventricular ejection fraction and end-diastolic volume, respectively (r = 0.63, r = 0.68). These results show that severe pulmonary regurgitation, significant annular or central pulmonary stenosis and preoperative hypoxia are major contributing factors to right ventricular dysfunction after surgical repair of tetralogy of Fallot. The postoperative left ventricular dysfunction can be largely attributed to dysfunction of the right ventricle.

Cardiac Catheterization↗
PubMed1994

Disorders of ventricular contractility and electrogenesis in the early stage of endotoxin shocked rabbits.

This is a report on ventricular contractility and electrogenesis disorders in rabbits, following intravenous injection of E. coli endotoxin at a dose of 2 mg.kg-1. At the 30th min, the right ventricular contractility indices (dP/dtmax)/P and [(dP/dt)/P]max had lower values, whereas end diastolic pressure (EDP), right ventricular systolic pressure (RVSP) and P(dP/dtmax) showed higher values compared to the initial ones. Most of the left ventricular contractility indices tested showed significantly lower values at the 30th and 60th min of the registration. In the scalar orthogonal ECG leads, at the 5th min an increased Qz amplitude, and at the 60th min an increased Rz amplitude, a decreased Ry amplitude, and QRS complex widening and bradicardia, were registered. In the spatial magnitude curve an increased amplitude of the main vectors of ventricular depolarization was documented. The changes in electrogenesis are interpreted first and foremost by the presence of hemodynamic disorders. The inference is reached that both left and right ventricular dysfunction have been already formed during the initial stage of endotoxin shock.

Animals↗
PubMed2005

Heart disease among children with HIV/AIDS attending the paediatric infectious disease clinic at Mulago Hospital.

BACKGROUND: There are very few published studies of heart disease in HIV infected children living in sub-Saharan Africa, a region with more than 50% of the world's population of HIV infected patients. OBJECTIVES: To determine the prevalence, and describe the type and clinical presentation of heart disease among children with HIV attending an ambulatory clinic. METHODOLOGY: Two hundred and thirty (230) HIV infected children attending the Paediatric Infectious Disease Clinic at Mulago hospital were recruited by simple random sampling in a cross-sectional study. The children were evaluated clinically, and investigated by electrocardiography and echocardiography. RESULTS: Thirty-two children (13.9%) had asymptomatic HIV disease, 156 (67.8%) had AIDS related complex while 42 (18.3%) had AIDS. Heart abnormalities were detected in 51% of the children (40.0% by echocardiography alone and 26.5% by electrocardiography alone). Heart abnormalities were most prevalent in children with AIDS (76.2%) and least prevalent in children with asymptomatic HIV disease (25.0%). The abnormalities included; Sinus tachycardia (21%), left ventricular systolic dysfunction (17%), right ventricular dilatation (14%), congenital heart disease (4.8%), dilated cardiomyopathy (3.0%), pericarditis (2.2%) and cor pulmonale (1.3%). Children with left ventricular systolic dysfunction significantly had easy fatigability, dyspnoea on exertion and tachypnoea. Other heart abnormalities presented with non-specific clinical features. CONCLUSION: Heart abnormalities were common especially in children with symptomatic HIV disease and included sinus tachycardia, left ventricular systolic dysfunction and right ventricular dilatation. The detected heart abnormalities, except left ventricular systolic dysfunction, had non-specific clinical features.

Adolescent↗
PubMed1988

The effects of an intravenous infusion of isosorbide dinitrate during open heart surgery.

Recent awareness of right ventricular dysfunction during open heart surgery has focused attention upon the importance of protection of the right ventricle and control of right ventricular afterload for the maintenance of the cardiac output. Conventional doses of systemic vasodilators, when used to reduce pulmonary vascular resistance, may produce systemic hypotension, reduce coronary arterial perfusion and even lower the cardiac output. A study of the effects of bolus intravenous isosorbide dinitrate during open heart surgery showed that following cardiopulmonary bypass intravenous isosorbide dinitrate produced highly significant falls in pulmonary artery pressure and induced active pulmonary vasodilatation without systemic side-effects or reduced atrial filling procedures. Treatment with intravenous isosorbide dinitrate by low-dose infusion during and after open heart surgery significantly lowered mean pulmonary artery pressure and pulmonary vascular resistance (P less than 0.001) in patients receiving no sympathomimetic drug support. The results suggest that possibly the effect of low-dose isosorbide dinitrate following cardiopulmonary by-pass is exerted predominantly on the right ventricular afterload if systemic arterial pressure is not elevated. This may have applications in the management of pulmonary hypertension and of acute right heart failure following cardiac surgery.

Adult↗
PubMed1994

[Right ventricular function after aorto-coronary bypass surgery: with relation to the site of right coronary artery occlusion].

Postoperative right ventricular function was evaluated serially by thermodilution techniques (REF-1, Edwards Laboratories) in patients who underwent aorto-coronary bypass surgery with uneventful postoperative recovery. The patients were divided into three groups depending on the location of critical stenosis of the right coronary artery. The stenosis was proximal to the right ventricular branch in group I (n = 13), distal to the right ventricular branch but proximal to the acute marginal branch in group II (n = 13) and distal to the acute marginal branch in group III (n = 11). Control (n = 20) consisted of the patients with no significant stenosis of the right coronary artery. Cardiac index, intracardiac pressures and amount of cathecolamin used during postoperative course showed no significant differences among the groups including control. With the use of cathecolamine after surgery, right ventricular ejection fraction (RVEF) rose and right ventricular volumes (RVEDV and RVESV) decreased in all the groups except for group I. These values in group I were unchanged. Thus, there were significant differences in RVEF, RVEDV and RVESV between group I and control. These results mean that right ventricular dysfunction may remain even long after occlusion of the proximal right coronary artery.

Aged↗
PubMedDate not supplied

Does a critical hemodynamic situation develop from right ventriculotomy and free wall infarct or from small changes in dysfunctional right ventricle afterload?

An experimental model for right ventricle free wall infarct associated with double ventriculotomy and tricuspid insufficiency was created to evaluate whether right ventricle failure can cause profound refractory heart failure or whether modifications in right ventricular afterload are more influential in this regard. In our model, the left ventricle, interventricular septum and right atrial wall were maintained intact and pulmonary banding made it possible to modify right ventricular afterload during the experiment. The results of our study showed that pure right ventricular failure does affect the hemodynamic state negatively, but it is not itself, a cause of death in dogs. A slight increase in the dysfunctional right ventricular afterload produced a profound deterioration in the hemodynamic state that required pulmonary artery debanding within no more than 10 minutes.

Animals↗
PubMed1994

Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension.

Single-lung transplantation has been successfully performed in patients with pulmonary fibrosis and emphysema. In contrast, patients with end-stage pulmonary hypertension (either primary or secondary to Eisenmenger's syndrome) have conventionally been offered heart-lung transplantation. The rationale underlying this approach is that chronic pulmonary hypertension results in irreversible right ventricular dilatation and failure. Recovery of the right ventricle has previously been reported after thromboendarterectomy for chronic large-vessel pulmonary embolism, correction of atrial septal defect or mitral valve replacement. The evolution of right ventricular morphology and function after lung transplantation has not been previously described. This study examines the reversibility of right ventricle dysfunction following normalization of pulmonary artery pressure after single-lung transplantation in 4 patients with pulmonary hypertension. Cardiac function was assessed using electrocardiography, echocardiography and radionuclide angiography. Pulmonary hemodynamic measurements, including pulmonary artery pressure and pulmonary vascular resistance, decreased in all patients after single-lung transplantation. Electrocardiographic changes observed were leftward shift in the QRS axis, and a decrease in P-wave amplitude and in right ventricular force. Echocardiographic examination revealed decreased right atrial, right ventricular and tricuspid valve annular dimensions, normalization of septal motion, and decreased tricuspid regurgitation. Thus, improved pulmonary hemodynamics after single-lung transplantation for pulmonary vascular disease results in reversal of right heart dilatation and dysfunction, and improved myocardial performance. The extent of right ventricular dysfunction beyond which recovery is unlikely to occur has yet to be determined.

Adult↗
PubMed2004

Should thrombolytic therapy be used in patients with pulmonary embolism?

More than thirty years have passed since streptokinase was first shown to dissolve pulmonary arterial thrombi and normalize pulmonary artery pressure in patients with acute pulmonary embolism (PE). Following the initial observations, a number of controlled clinical trials confirmed that treatment with streptokinase, urokinase or alteplase recombinant tissue plasminogen activator is superior to heparin alone in improving angiographic and hemodynamic parameters in these patients. At present, there is consensus that patients with massive PE presenting with overt right ventricular failure (clinical instability and cardiogenic shock) should promptly be treated with thrombolytic agents, since they are at a particularly high risk for death or life-threatening complications during the acute phase. At the other end of the clinical spectrum, thrombolysis for PE is not indicated in the absence of right ventricular dysfunction. In fact, the prognosis of patients with small pulmonary emboli (not affecting pulmonary artery pressure and right ventricular afterload), is excellent and, as a result, the bleeding risks of thrombolysis may outweigh the potential benefits of this treatment. Currently, the thrombolysis debate focuses on patients with submassive PE, i.e. those who present with signs of subclinical, impending right heart failure. Recently, a number of clinical studies demonstrated that these patients are also at risk for an adverse clinical outcome. Besides the established prognostic value of echocardiography, evidence is now accumulating that cardiac troponins and, possibly, pro-brain natriuretic peptide levels also may permit an early, reliable risk stratification of patients with PE and particularly help identify submassive PE in the presence of apparent clinical stability. Recently, the Management Strategies and Prognosis of Pulmonary Embolism-3 trial examined the effects of thrombolysis on the prognosis of patients with acute submassive PE. The study patients were randomly assigned to receive alteplase (100 mg over 2 hours) or placebo with concomitant heparin anticoagulation. Although in-hospital mortality was low in both the alteplase and the heparin-only group, this study showed for the first time that early treatment with alteplase can improve the clinical course of patients with acute submassive PE, and particularly reduce the need for emergency escalation of treatment. Importantly, no fatal or cerebral bleeding episodes were observed in the alteplase group. This fact indicates that use of thrombolysis in PE can be safe in patients who have no contraindications to this type of treatment. Based on these data, the indications for thrombolysis can be extended to include patients presenting with submassive PE.

Clinical Trials as Topic↗
PubMed1992

Coronary artery operation in radiation-associated atherosclerosis: long-term follow-up.

Radiation-associated coronary atherosclerosis is a potential problem for patients who have had mediastinal irradiation for malignant tumors. This study identified 14 patients with radiation-associated coronary atherosclerosis, defines unique population characteristics, and analyses postsurgical problems and long-term outcome. Fourteen patients with radiation-associated coronary atherosclerosis and class III and IV New York Heart Association symptoms were identified because of mediastinal or chest wall irradiation (30 Gy) associated with anterior epicardial discoloration or fibrosis, aortitis with adventitial thickening, and inflammatory process over a proximal coronary artery. Two distinct treatment groups were analyzed. Coronary artery operation resulted in one hospital death, with vein grafts being used predominantly. The internal mammary artery could only be used in 3 patients because of vessel friability and mediastinal fibrosis. Postoperative right ventricular dysfunction and pulmonary problems were frequent. Severe pericardial inflammatory complications (fibrosis with graft closure, and constrictive pericarditis) present in 2 early patients resulted in routine anterior pericardiectomy after coronary artery operation without further problems. Long-term follow-up (100%) (range, 11 to 74 months) revealed that 1 patient died late and of the remainder (12 patients), 11 were in New York Heart Association class I and 1 in class II, experiencing three myocardial events. Thus, patients with radiation-associated coronary atherosclerosis have a low operative mortality but have risk of early right ventricular and pulmonary dysfunction. The routine use of internal mammary artery may not be possible and anterior pericardiectomy is recommended. Long-term results are excellent and no evidence of accelerated disease has been noted.

Adult↗
PubMed2004

Right ventricular volume measurements in ventilated preterm neonates.

Pulmonary hypertension is associated with worse perinatal outcomes in infants with respiratory disorders. In these infants, right ventricular dysfunction may result in poor pulmonary blood flow. The objective of this study was to follow changes in right ventricular volumes during the first 2 days of life in infants with respiratory distress syndrome. Serial echocardiographic examinations were performed on days 0-2 on infants ventilated for respiratory distress syndrome. Two-dimensional echocardiography with the ellipsoid approximation was used to calculate systolic and diastolic volumes. In 17 ventilated preterm infants, right ventricular volumes were significantly lower on day 2 compared with day 0 and decreased from a median (interquartile range) end systolic volume of 0.80 ml/kg (0.66-0.91 ml/kg) to 0.45 ml/kg (0.39-0.54 ml/kg) ( p < 0.001). End diastolic volume decreased from a median (interquartile range) of 1.54 ml/kg (1.44-1.65 ml/kg) to 1.30 ml/kg (1.22-1.60 ml/kg) ( p = 0.039). Right ventricular ejection fraction increased from a median (interquartile range) of 0.48 ml/kg (0.44-0.56 ml/kg) to 0.62 ml/kg (0.58-0.71 ml/kg) during the same period ( p < 0.001), as did right ventricular output from a median (interquartile range) 120 ml/kg/min (96-125 ml/kg/min) to 140 ml/kg/min (113-168 ml/kg/min) ( p = 0.044). Right ventricular volume decreases during the first 2 days of life in ventilated preterm infants. However, right ventricular performance is maintained.

Cardiotonic Agents↗
PubMed1982

Noninvasive quantitation of right-ventricular volume overload in adults by gated equilibrium radionuclide angiography.

R-wave-synchronized equilibrium radionuclide angiography (RNA) is a noninvasive method whose time-activity curves provide count information that is proportional to ventricular volume. We have performed resting gated RNA in nine consecutive adult patients undergoing cardiac catheterization for evaluation of left-to-right shunting. Pulmonary/systemic flow ratios (Qp/Qs) calculated from RNA correlated well with Qp/Qs defined by oximetry (r = 0.87, y = 0.85x + 0.11, sy . x = 0.46). In five patients imaged before, and within 1 mo after, successful surgical repair, RNA Qp/Qs declined from a mean (+/- s.d.) of 2.9 +/- 1.0 to 1.1 +/- 0.2. Right/left ventricular end-diastolic volume ratios declined from 3.1 +/- 1.3 to 1.7 +/- 0.2. Although left-ventricular ejection fraction did not change, right-ventricular ejection fraction declined in these patients. Imaging in nine patients with right-ventricular dysfunction, but without shunt or regurgitation, yielded a mean Qp/Qs of 0.94 +/- 0.27. We conclude that Qp/Qs, right-ventricular ejection fraction, and relative ventricular enlargement may be accurately quantitated and followed serially after therapeutic intervention using gated RNA.

Adult↗
PubMed1999

Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass.

OBJECTIVE: In off-pump coronary surgery, exposure of posterior vessels via sternotomy causes deterioration of cardiac function. Changes in ventricular geometry, valve competence, and hemodynamics after retraction of the beating heart were studied. Subsequently, the modifying effect of right or left heart bypass was investigated. METHODS: In six 80-kg pigs, an ultrasound probe was attached to the backside of the left ventricle and the heart was fully retracted with a suction tissue stabilizer. Five pigs underwent additional pump support. RESULTS: During retraction, the right ventricle was squeezed between the pericardium and interventricular septum, thereby decreasing its diastolic cross-sectional area by 62% +/- 6% (P <.001) while, concomitantly, right ventricular end-diastolic pressure increased to 165% +/- 19% (P =.004) of basal values. Stroke volume and mean arterial pressure decreased by 29% +/- 6% and 23% +/- 8% (P =.007 and P =.02, respectively). Left ventricular shape became somewhat elliptic without changes in preload pressure, and its diastolic cross-sectional area decreased by 20% +/- 3% (P =.001). All valves were competent. Right heart bypass restored left ventricular cross-sectional area, stroke volume, and mean arterial pressure. In contrast, left heart bypass increased blood pressure only marginally. CONCLUSIONS: Ninety-degree anterior displacement of the beating porcine heart caused primarily right ventricular dysfunction as a result of mechanical interference with diastolic expansion without concurring valvular incompetence. Right heart bypass normalized stroke volume and mean arterial pressure by increasing left ventricular preload; in contrast, left heart bypass failed to restore systemic circulation.

Animals↗
PubMed2005

Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure.

BACKGROUND: The presence of right ventricular systolic dysfunction is known to significantly worsen prognosis of patients with heart failure. However, the prognostic impact of right ventricular diastolic dysfunction and of its combination with right ventricular systolic dysfunction and with other prognostic markers has not yet been systematically studied. The aim of this study was to assess the prognostic impact of combined right ventricular systolic and diastolic dysfunction in patients with symptomatic heart failure due to ischemic or idiopathic dilated cardiomyopathy. METHODS: The study included 177 consecutive patients with symptomatic heart failure (mean left ventricular ejection fraction of 23%). All patients underwent clinical and laboratory examination, standard echocardiography completed by Doppler tissue imaging of the tricuspid annular motion, and right-sided heart catheterization. They were followed up for a mean period of 16 months (range, 1-48 months). RESULTS: During the follow-up, there were 28 cardiac-related deaths and 35 non-fatal cardiac events (31 hospitalizations for heart failure decompensation and 4 hospitalizations for malignant arrhythmias requiring the implantation of a cardioverter-defibrillator). The multivariate stepwise Cox regression modeling revealed the right ventricular systolic (represented by the peak systolic tricuspid annular velocity-Sa) and diastolic (represented by the peak early diastolic tricuspid annular velocity-Ea) function to be the independent predictors of event-free survival or survival (p<0.01). The Sa separated better between patients with and without the risk of cardiac events (p<0.05), while the Ea appeared to further distinguish patients with increased risk (those at risk of late event from those at risk of early non-fatal event and early death). The strongest predictive information was obtained by the combination of Sa and Ea creating the Sa/Ea categories. The Sa/Ea I category of patients (Sa>or=10.8 cm s(-1) and Ea>or=8.9 cm s(-1)) had excellent prognosis. On the other hand, the Sa/Ea IV category (Sa<10.8 cm s(-1) and Ea<8.9 cm s(-1)) was found to be at a very high risk of cardiac events (p<0.001 vs. Sa/Ea I). Imbalanced categories of patients (Sa/Ea II and III) with only one component (Sa or Ea) pathologically decreased were at medium risk when assessing event-free survival. However, a significantly better survival (p<0.05) was found in patients with Ea>or=8.9 cm s(-1) (Sa/Ea I and III categories) as compared with those having Ea<8.9 cm s(-1) (Sa/Ea II and IV categories). Thus, in contrast to event-free survival, the survival pattern was determined mainly by the Ea value with only little additional contribution of Sa. CONCLUSIONS: The assessment of right ventricular systolic and diastolic function provides complementary information with a very high power to stratify prognosis of patients with heart failure. The combination of right ventricular systolic and diastolic dysfunction identifies those with a very poor prognosis.

Blood Flow Velocity↗
PubMed2004

The natriuretic peptides and their role in disorders of right heart dysfunction and pulmonary hypertension.

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are increased in conditions with cardiac ventricular volume and pressure overload. The general physiological and potential therapeutic roles of natriuretic peptides in respiratory disease, right ventricular (RV) dysfunction, and pulmonary arterial hypertension (PAH) are reviewed. BNP levels can be used to differentiate between dyspneic patients with a pure respiratory defect and those with RV dysfunction. BNP levels also correlate with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with PAH (atrial septal defect, chronic thromboembolic disease, and scleroderma). BNP is a predictor of mortality in patients with primary pulmonary hypertension (PPH). These are important clinical implications in that a noninvasive blood test may be used to identify high-risk patients for more invasive procedures such as cardiac catheterization. BNP or NT-proBNP measurements may also be used to guide therapy (e.g., pulmonary vasorelaxants) in PAH since upregulation of the natriuretic peptide pathway has been shown to reduce cardiac hypertrophy and PAH. Additionally, there may be therapeutic potential via recombinant BNP or neutral endopeptidase inhibitors in RV dysfunction and PAH.

Animals↗