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Clinical Cardiology Jul 2017A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies... (Review)
Review
BACKGROUND
A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic.
HYPOTHESIS
Chemotherapy induces RV structural, functional, and mechanical changes.
METHODS
We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab."
RESULTS
The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment.
CONCLUSIONS
Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.
Topics: Antineoplastic Agents; Diastole; Echocardiography; Heart Failure; Heart Ventricles; Humans; Neoplasms; Stroke Volume; Systole; Ventricular Dysfunction, Right; Ventricular Function, Right; Ventricular Remodeling
PubMed: 28191909
DOI: 10.1002/clc.22672 -
Physiological Reports Jan 2020Chronic hypoxia from diseases in the lung, such as pulmonary hypertension, pulmonary fibrosis, and chronic obstructive pulmonary disease, can increase pulmonary vascular...
Chronic hypoxia from diseases in the lung, such as pulmonary hypertension, pulmonary fibrosis, and chronic obstructive pulmonary disease, can increase pulmonary vascular resistance, resulting in hypertrophy and dysfunction of the right ventricle (RV). In order to obtain insight into RV biology and perhaps uncover potentially novel therapeutic approaches for RV dysfunction, we performed RNA-sequencing (RNA-seq) of RV and LV tissue from rats in normal ambient conditions or subjected to hypoxia (10% O ) for 2 weeks. Gene ontology and pathway analysis of the RV and LV revealed multiple transcriptomic differences, in particular increased expression in the RV of genes related to immune function in both normoxia and hypoxia. Immune cell profiling by flow cytometry of cardiac digests revealed that in both conditions, the RV had a larger percentage than the LV of double-positive CD45 /CD11b/c cells (which are predominantly macrophages and dendritic cells). Analysis of gene expression changes under hypoxic conditions identified multiple pathways that may contribute to hypoxia-induced changes in the RV, including increased expression of genes related to cell mitosis/proliferation and decreased expression of genes related to metabolic processes. Together, the findings indicate that the RV differs from the LV with respect to content of immune cells and expression of certain genes, thus suggesting the two ventricles differ in aspects of pathophysiology and in potential therapeutic targets for RV dysfunction.
Topics: Animals; Dendritic Cells; Heart Ventricles; Hypoxia; Macrophages; Male; Rats; Transcriptome
PubMed: 31960631
DOI: 10.14814/phy2.14344 -
Journal of the American College of... Feb 2022
Topics: Cardiac Surgical Procedures; Heart Ventricles; Humans; Pulmonary Artery; Tricuspid Valve; Tricuspid Valve Insufficiency
PubMed: 35115102
DOI: 10.1016/j.jacc.2021.11.030 -
Cardiology Journal 2016Pulmonary valve insufficiency may develop after surgical treatment of tetralogy of Fallot (ToF). Severe pulmonary valve insufficiency may result in right ventricular...
BACKGROUND
Pulmonary valve insufficiency may develop after surgical treatment of tetralogy of Fallot (ToF). Severe pulmonary valve insufficiency may result in right ventricular dysfunction. We aimed to compare cardiac magnetic resonance (CMR), with echocardiography.
METHODS
Patients who developed severe pulmonary valve insufficiency after total correction for ToF, were included in the study. CMR was used to measure end-diastolic, end-systolic volumes and ejection fraction of the right ventricle before and 6 months after replacement, and echocar-diographic strain imaging was obtained before, and 1, 3, and 6 months after replacement.
RESULTS
There were significant differences between pre- and post-replacement QRS durations, and right ventricle end-diastolic and end-systolic volumes measured with CMR (p < 0.05). However, right ventricular ejection fraction (RVEF) did not change. Therefore, CMR determined that right ventricle size and volume increased, and right ventricular function deteriorated before replacement. After replacement, no significant improvement was seen in RVEF. Lower-than-normal right ventricle strain and strain rate before replacement indicated that healthy and dysfunctional myocardium could be differentiated by this method. Pre-replacement strain and strain rate of asymptomatic and symptomatic patients were similar. Strain and strain rate values increased 6 months after replacement (p < 0.05).
CONCLUSIONS
We suppose that increased experience with strain imaging, and further studies on a larger patient group with a longer follow-up period would show that this method is quite advantageous, and it will take its place in the literature as a non-invasive technique that may be used instead of magnetic resonance.
Topics: Adolescent; Child; Echocardiography; Female; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Male; Prognosis; Pulmonary Valve; Pulmonary Valve Insufficiency; Ventricular Dysfunction, Right; Ventricular Function, Right; Young Adult
PubMed: 26779972
DOI: 10.5603/CJ.a2016.0007 -
Circulation Research Jun 2014The right ventricle (RV) is the major determinant of functional state and prognosis in pulmonary arterial hypertension. RV hypertrophy (RVH) triggered by pressure... (Review)
Review
The right ventricle (RV) is the major determinant of functional state and prognosis in pulmonary arterial hypertension. RV hypertrophy (RVH) triggered by pressure overload is initially compensatory but often leads to RV failure. Despite similar RV afterload and mass some patients develop adaptive RVH (concentric with retained RV function), while others develop maladaptive RVH, characterized by dilatation, fibrosis, and RV failure. The differentiation of adaptive versus maladaptive RVH is imprecise, but adaptive RVH is associated with better functional capacity and survival. At the molecular level, maladaptive RVH displays greater impairment of angiogenesis, adrenergic signaling, and metabolism than adaptive RVH, and these derangements often involve the left ventricle. Clinically, maladaptive RVH is characterized by increased N-terminal pro-brain natriuretic peptide levels, troponin release, elevated catecholamine levels, RV dilatation, and late gadolinium enhancement on MRI, increased (18)fluorodeoxyglucose uptake on positron emission tomography, and QTc prolongation on the ECG. In maladaptive RVH there is reduced inotrope responsiveness because of G-protein receptor kinase-mediated downregulation, desensitization, and uncoupling of β-adrenoreceptors. RV ischemia may result from capillary rarefaction or decreased right coronary artery perfusion pressure. Maladaptive RVH shares metabolic abnormalities with cancer including aerobic glycolysis (resulting from a forkhead box protein O1-mediated transcriptional upregulation of pyruvate dehydrogenase kinase), and glutaminolysis (reflecting ischemia-induced cMyc activation). Augmentation of glucose oxidation is beneficial in experimental RVH and can be achieved by inhibition of pyruvate dehydrogenase kinase, fatty acid oxidation, or glutaminolysis. Therapeutic targets in RV failure include chamber-specific abnormalities of metabolism, angiogenesis, adrenergic signaling, and phosphodiesterase-5 expression. The ability to restore RV function in experimental models challenges the dogma that RV failure is irreversible without regression of pulmonary vascular disease.
Topics: Animals; Cyclic Nucleotide Phosphodiesterases, Type 5; Familial Primary Pulmonary Hypertension; Fibrosis; Glycolysis; Heart Failure; Heart Ventricles; Humans; Hypertension, Pulmonary; Hypertrophy, Right Ventricular; Neovascularization, Pathologic; Receptors, Adrenergic, beta; Signal Transduction; Ventricular Function, Right
PubMed: 24951766
DOI: 10.1161/CIRCRESAHA.113.301129 -
Journal of the American College of... Sep 2022
Topics: Heart Failure; Heart Ventricles; Humans; Transposition of Great Vessels
PubMed: 36049803
DOI: 10.1016/j.jacc.2022.06.021 -
The International Journal of... Dec 2021Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute... (Review)
Review
Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute and chronic respiratory diseases, its assessment in SARS-CoV-2 infected patients may add prognostic accuracy. Transthoracic echocardiography has been proposed to early predict myocardial injury and risk of death in hospitalized patients. This systematic review presents the up-to-date sum of literature regarding right ventricle ultrasound assessment. We evaluated commonly used echocardiographic parameters to assess RV function and discussed their relationship with pathophysiological mechanisms involved in COVID-19. We searched Medline and Embase for studies that used transthoracic echocardiography for right ventricle assessment in patients with COVID-19.
Topics: COVID-19; Echocardiography; Heart Ventricles; Humans; Predictive Value of Tests; SARS-CoV-2; Ventricular Dysfunction, Right
PubMed: 34292433
DOI: 10.1007/s10554-021-02353-6 -
Advances in Respiratory Medicine 2020Acute respiratory distress syndrome (ARDS) is a life-threatening chest disease associated with a poor outcome and increased mortality. It may lead to pulmonary... (Observational Study)
Observational Study
INTRODUCTION
Acute respiratory distress syndrome (ARDS) is a life-threatening chest disease associated with a poor outcome and increased mortality. It may lead to pulmonary hypertension and, eventually, right ventricular failure. These changes can be investigated by transthoracic echocardiography (TTE) which is considered a non-invasive and cost-effective modality. We studied the role of right ventricular function in the prediction of the severity and mortality in ARDS.
MATERIAL AND METHODS
In this observational study, 94 patients suffering from ARDS were subjected to TTE to evaluate the parameters of right ventricular function by measuring tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV-FAC), myocardial performance index (Tei index), and systolic pulmonary artery pressure (SPAP) to assess their relation to the severity and mortality in ARDS.
RESULTS
TAPSE, SPAP, Tei index, and RV-FAC showed significant differences between survivors and non-survivors after 30 days (all p < 0.001). An increased length of intensive care unit stay was significantly correlated with TAPSE, Tei index, and RV-FAC (p = 0.002' 0.007' and 0.013, respectively). Meanwhile, the length of mechanical ventilation days was significantly correlated with the Tei index only (p < 0.001). Multivariate regression analysis found that TAPSE and the Tei index were independent factors affecting mortality (p = 0.004' and 0.006, respectively). RV-FAC, with a cut-off point ≤ 57%, had the highest sensitivity' while TAPSE, with a cut-off point ≤ 17 mm, had the highest specificity to predict mortality.
CONCLUSIONS
Transthoracic echocardiographic parameters of the right ventricle could be used to predict severity and mortality in patients with ARDS with high sensitivity and specificity.
Topics: Dyspnea; Echocardiography; Heart Ventricles; Humans; Hypertension, Pulmonary; Respiratory Distress Syndrome; Treatment Outcome; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 33169813
DOI: 10.5603/ARM.a2020.0153 -
Revista Espanola de Cardiologia Jan 2010The primary purpose of the right ventricle and pulmonary circulation is gas exchange. Because gas exchange occurs in thin, highly permeable alveolar membranes, pulmonary...
The primary purpose of the right ventricle and pulmonary circulation is gas exchange. Because gas exchange occurs in thin, highly permeable alveolar membranes, pulmonary pressure must remain low to avoid pulmonary edema; because the right ventricle and the lungs are in series with the left ventricle and the systemic circulation, the entire cardiac output must pass through the lungs. This low pressure, high volume system, makes dramatically different demands on the right ventricle compared with the demands made on the left ventricle by the systemic circulation. Moreover, the right ventricle and pulmonary circulation must buffer dynamic changes in blood volume and flow resulting from respiration, positional changes, and changes in left ventricular cardiac output. The optimizations needed to meet these conflicting demands result in reduced capacity to compensate for increased afterload or pressure. Unfortunately, a large number of pathologic processes can result in acute and or chronic increases in afterload stress. As afterload stress rises, right heart failure may develop, and hemodynamic instability and death can occur abruptly. Several biochemical pathways have been identified that may participate in adaptation or maladaptation to excessive pressure loads.
Topics: Adult; Fetus; Heart Failure; Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Infant, Newborn; Pulmonary Circulation; Ventricular Function, Right
PubMed: 20089229
DOI: 10.1016/s1885-5857(10)70012-8 -
Current Problems in Cardiology Sep 2022The right and left ventricle of heart are intimately connected by anatomical and functional links. Hence, acute changes in cardiac geometry and function can modify the... (Review)
Review
The right and left ventricle of heart are intimately connected by anatomical and functional links. Hence, acute changes in cardiac geometry and function can modify the performance and physiology of both sides of the heart, influencing each other. After a brief overview of the anatomy and related imaging techniques for the study of right ventricular function, we report a review-on the interesting correlation of acute anterior myocardial infarction and right ventricular function, very often underestimated.
Topics: Heart Ventricles; Humans; Myocardial Infarction; Ventricular Function, Right
PubMed: 35661811
DOI: 10.1016/j.cpcardiol.2022.101277