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The Journal of Thoracic and... Oct 2021
Topics: Fontan Procedure; Humans; Pulmonary Circulation; Pyrimidines; Sulfonamides
PubMed: 33451847
DOI: 10.1016/j.jtcvs.2020.11.121 -
Revue Des Maladies Respiratoires Dec 2018The right ventricle (RV) plays a key role in the maintenance of an adequate cardiac output whatever the demand, and thus contributes to the optimization of the... (Review)
Review
The right ventricle (RV) plays a key role in the maintenance of an adequate cardiac output whatever the demand, and thus contributes to the optimization of the ventilation/perfusion ratio. The RV has a thin wall and it buffers the physiological increases in systemic venous return without causing a deleterious rise in right atrial pressure (RAP). The RV is coupled to the pulmonary circulation which is a low pressure, low resistance, high compliance system. In the healthy subject at rest, the contribution of the RV to right heart systolic function is surpassed by the contribution of both left ventricular contraction and the respiratory pump. RV systolic function plays a contributory role during exercise and in patients with pulmonary hypertension. The RV compensates better for volume overload than for pressure overload and is more capable of sustaining chronic increases in load than acute ones. An impaired RV-pulmonary artery coupling leads to a major mismatch between RV function and arterial load ("afterload mismatch") and is associated progressively with a low cardiac output and a high RAP. Right ventricular dysfunction is involved in the pathophysiology of both cardiovascular and pulmonary diseases, and may partly explain the deleterious haemodynamic consequences of mechanical ventilation.
Topics: Adaptation, Physiological; Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Circulation; Stroke Volume; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 29945812
DOI: 10.1016/j.rmr.2017.10.667 -
International Journal of Molecular... Jun 2023Pulmonary hypertension (PH) associated with left heart diseases (PH-LHD), also termed group 2 PH, represents the most common form of PH. It develops through the passive... (Review)
Review
Pulmonary hypertension (PH) associated with left heart diseases (PH-LHD), also termed group 2 PH, represents the most common form of PH. It develops through the passive backward transmission of elevated left heart pressures in the setting of heart failure, either with preserved (HFpEF) or reduced (HFrEF) ejection fraction, which increases the pulsatile afterload of the right ventricle (RV) by reducing pulmonary artery (PA) compliance. In a subset of patients, progressive remodeling of the pulmonary circulation resulted in a pre-capillary phenotype of PH, with elevated pulmonary vascular resistance (PVR) further increasing the RV afterload, eventually leading to RV-PA uncoupling and RV failure. The primary therapeutic objective in PH-LHD is to reduce left-sided pressures through the appropriate use of diuretics and guideline-directed medical therapies for heart failure. When pulmonary vascular remodeling is established, targeted therapies aiming to reduce PVR are theoretically appealing. So far, such targeted therapies have mostly failed to show significant positive effects in patients with PH-LHD, in contrast to their proven efficacy in other forms of pre-capillary PH. Whether such therapies may benefit some specific subgroups of patients (HFrEF, HFpEF) with specific hemodynamic phenotypes (post- or pre-capillary PH) and various degrees of RV dysfunction still needs to be addressed.
Topics: Humans; Hypertension, Pulmonary; Heart Failure; Stroke Volume; Pulmonary Circulation; Hemodynamics
PubMed: 37373119
DOI: 10.3390/ijms24129971 -
Internal Medicine (Tokyo, Japan) Feb 2023
Topics: Humans; Hypertension, Pulmonary; Pulmonary Circulation; Thromboembolism; Pulmonary Embolism; Chronic Disease
PubMed: 35793955
DOI: 10.2169/internalmedicine.0017-22 -
Pulmonary Pharmacology & Therapeutics Dec 2014In chronic lung disorders such as in asthma and chronic obstructive pulmonary disease (COPD) there is increased bronchial angiogenesis and remodelling of pulmonary... (Review)
Review
In chronic lung disorders such as in asthma and chronic obstructive pulmonary disease (COPD) there is increased bronchial angiogenesis and remodelling of pulmonary vessels culminating to altered bronchial and pulmonary circulation. The involvement of residential cells such as endothelial cells, smooth muscle cells and pulmonary fibroblasts, all appear to have a crucial role in the progression of vascular inflammation and remodelling. The regulatory abnormalities, growth factors and mediators implicated in the pulmonary vascular changes of asthma and COPD subjects and potential therapeutic targets have been described in this review.
Topics: Animals; Asthma; Humans; Lung; Pulmonary Circulation; Pulmonary Disease, Chronic Obstructive; Vascular Remodeling
PubMed: 25316209
DOI: 10.1016/j.pupt.2014.09.003 -
Heart Failure Clinics Jul 2018The different components of the right heart pulmonary circulation unit can be investigated by MRI and computed tomography. MRI has clear advantages over echocardiography... (Review)
Review
The different components of the right heart pulmonary circulation unit can be investigated by MRI and computed tomography. MRI has clear advantages over echocardiography for accurate definition of right heart function and structure and to derive functional information regarding the pulmonary vasculature. Computed tomography is superior for the assessment of parenchymal and vascular pathologies of the lung with indications in the diagnostic work-up of pulmonary hypertension, but with more limited capability to evaluate right ventricular function and in deriving pulmonary hemodynamics. Recent technical developments with these imaging modalities could allow a better evaluation of the right heart pulmonary circulation unit.
Topics: Echocardiography; Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Magnetic Resonance Imaging; Pulmonary Circulation; Tomography, X-Ray Computed; Ventricular Function, Right
PubMed: 29966635
DOI: 10.1016/j.hfc.2018.03.004 -
The Journal of Thoracic and... Oct 2021
Topics: Fontan Procedure; Hemodynamics; Homeostasis; Humans; Models, Cardiovascular; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Pulmonary Circulation; Treatment Outcome; Univentricular Heart; Vascular Resistance
PubMed: 33618865
DOI: 10.1016/j.jtcvs.2020.08.114 -
Journal of the American Society of... May 2018The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered... (Review)
Review
The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.
Topics: Echocardiography, Stress; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Circulation; Reproducibility of Results; Ventricular Function, Right
PubMed: 29573927
DOI: 10.1016/j.echo.2018.01.002 -
Chest Jul 2018Exercise stress testing of the pulmonary circulation for the diagnosis of latent or early-stage pulmonary hypertension (PH) is gaining acceptance. There is emerging... (Review)
Review
Exercise stress testing of the pulmonary circulation for the diagnosis of latent or early-stage pulmonary hypertension (PH) is gaining acceptance. There is emerging consensus to define exercise-induced PH by a mean pulmonary artery pressure > 30 mm Hg at a cardiac output < 10 L/min and a total pulmonary vascular resistance> 3 Wood units at maximum exercise, in the absence of PH at rest. Exercise-induced PH has been reported in association with a bone morphogenetic receptor-2 gene mutation, in systemic sclerosis, in left heart conditions, in chronic lung diseases, and in chronic pulmonary thromboembolism. Exercise-induced PH is a cause of decreased exercise capacity, may precede the development of manifest PH in a proportion of patients, and is associated with a decreased life expectancy. Exercise stress testing of the pulmonary circulation has to be dynamic and rely on measurements of the components of the pulmonary vascular equation during, not after exercise. Noninvasive imaging measurements may be sufficiently accurate in experienced hands, but suffer from lack of precision, so that invasive measurements are required for individual decision-making. Exercise-induced PH is caused either by pulmonary vasoconstriction, pulmonary vascular remodeling, or by increased upstream transmission of pulmonary venous pressure. This differential diagnosis is clinical. Left heart disease as a cause of exercise-induced PH can be further ascertained by a pulmonary artery wedge pressure above or below 20 mm Hg at a cardiac output < 10 L/min or a pulmonary artery wedge pressure-flow relationship above or below 2 mm Hg/L/min during exercise.
Topics: Cardiac Catheterization; Exercise; Exercise Test; Humans; Hypertension, Pulmonary; Pulmonary Circulation; Pulmonary Wedge Pressure; Risk Factors; Vascular Resistance
PubMed: 29382472
DOI: 10.1016/j.chest.2018.01.022 -
Heart Failure Clinics Jul 2018Valvular heart disease (VHD) is frequently accompanied by pulmonary hypertension (PH). In asymptomatic patients, PH is rare, although the exact prevalence is unknown and... (Review)
Review
Valvular heart disease (VHD) is frequently accompanied by pulmonary hypertension (PH). In asymptomatic patients, PH is rare, although the exact prevalence is unknown and mainly stems from the severity of the VHD and the presence of diastolic dysfunction. PH can also be depicted during exercise echocardiography. PH either at rest or during exercise is also a powerful determinant of outcome and is independently associated with reduced survival, regardless of the severity of the underlying valvular pathology. Therefore, because PH is a marker of poor prognosis, assessment of PH in VHD is crucial for risk stratification and management of patients with VHD.
Topics: Echocardiography; Exercise; Heart Valve Diseases; Heart Ventricles; Humans; Hypertension, Pulmonary; Prognosis; Pulmonary Circulation; Ventricular Dysfunction, Right
PubMed: 29966640
DOI: 10.1016/j.hfc.2018.03.009