title: Acute right ventricular pressure overload compromises left ventricular function by altering septal strain and rotation.
abstract: While right ventricular (RV) dysfunction has long been known to affect the performance of left ventricle (LV), the mechanisms remain poorly defined. Recently, speckle-tracking echocardiography has demonstrated that preservation of strain and rotational dynamics is crucial to both LV systolic and diastolic function. We hypothesized that alteration in septal strain and rotational dynamics of the LV occurs during acute RV pressure overload (RVPO) and leads to decreased cardiac performance. Seven anesthetized pigs underwent median sternotomy and placement of intraventricular pressure-volume conductance catheters. Two-dimensional echocardiographic images and LV pressure-volume loops were acquired for offline analysis at baseline and after banding of the pulmonary artery to achieve RVPO (>50 mmHg) induced RV dysfunction. RVPO resulted in a significant decrease (P < 0.05) in LV end-systolic elastance (50%), systolic change in pressure over change in time (19%), end-diastolic volume (22%), and cardiac output (37%) that correlated with decrease in LV global circumferential strain (58%), LV apical rotation (28%), peak untwisting (reverse rotation) rate (27%), and prolonged time to peak rotation (17%), while basal rotation was not significantly altered. RVPO reduced septal radial and circumferential strain, while no other segment of the LV midpapillary wall was affected. RVPO decreased septal radial strain on LV side by 27% and induced a negative radial strain from 28 ± 5 to -16 ± 2% on the RV side of the septum. The septal circumferential strain on both LV and RV side decreased by 46 and 50%, respectively, following RVPO (P < 0.05). Our results suggest that acute RVPO impairs LV performance by primarily altering septal strain and apical rotation.
authors: Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.
authors: Jason
authors: J
authors: Chua
authors: Wei
authors: W
authors: Zhou
authors: Jonathan K
authors: JK
authors: Ho
authors: Nikhil A
authors: NA
authors: Patel
authors: G Burkhard
authors: GB
authors: Mackensen
authors: Aman
authors: A
authors: Mahajan
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011651:Pulmonary Artery / Q000503:physiopathology; D012399:Rotation; D013552:Swine / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
keywords: pulmonary aortic banding; right ventricular failure; septal strain
references: Circulation. 2002 Apr 9;105(14):1693-9
references: 11940549
references: J Cardiovasc Magn Reson. 2008 Jul 04;10:33
references: 18601713
references: Echocardiography. 2007 May;24(5):522-32
references: 17456072
references: Circulation. 2005 Nov 15;112(20):3149-56
references: 16286606
references: Circ Res. 1955 Mar;3(2):133-9
references: 14352394
references: J Am Soc Echocardiogr. 2011 Jul;24(7):792-802
references: 21481566
references: J Card Surg. 2008 Jul-Aug;23(4):324-30
references: 18598321
references: Eur J Cardiothorac Surg. 2006 Apr;29 Suppl 1:S272-8
references: 16567103
references: Neurosci Res. 1998 Sep;32(1):47-56
references: 9831251
references: Coron Artery Dis. 2005 Feb;16(1):27-30
references: 15654196
references: Invest Radiol. 2007 Nov;42(11):777-89
references: 18030201
references: Eur J Cardiothorac Surg. 2006 Apr;29 Suppl 1:S126-38
references: 16564701
references: Circulation. 1995 Jul 1;92(1):130-41
references: 7788907
references: Cardiovasc Res. 1997 May;34(2):281-8
references: 9205541
references: J Am Soc Echocardiogr. 2005 May;18(5):435-44
references: 15891753
references: Am J Cardiol. 2006 Sep 1;98(5):699-704
references: 16923465
references: Eur Heart J. 2008 Mar;29(6):825; author reply 825-6
references: 18238928
references: Am J Physiol Heart Circ Physiol. 2003 Sep;285(3):H946-54
references: 12763752
references: J Am Soc Echocardiogr. 2011 Nov;24(11):1205-12
references: 21820866
references: Am J Physiol Heart Circ Physiol. 2007 Jul;293(1):H120-5
references: 17322423
references: Eur J Cardiothorac Surg. 2006 Apr;29 Suppl 1:S198-206
references: 16563786
references: Brain Res. 1986 Dec;396(4):359-91
references: 3542115
references: Am J Physiol Heart Circ Physiol. 2005 Aug;289(2):H501-12
references: 16014610
references: Circulation. 1990 Feb;81(2 Suppl):III15-20
references: 2297880
references: Eur J Cardiothorac Surg. 2006 Apr;29 Suppl 1:S115-25
references: 16564184
references: J Am Soc Echocardiogr. 2007 May;20(5):486-91
references: 17484988
references: Int J Cardiovasc Imaging. 2007 Aug;23(4):469-77
references: 17054014
references: Am J Physiol Heart Circ Physiol. 2006 Apr;290(4):H1528-33
references: 16284226
references: J Am Coll Cardiol. 2008 Jan 15;51(2):149-57
references: 18191740
references: J Am Soc Echocardiogr. 2010 Aug;23(8):823-31
references: 20646910
references: Ann Thorac Surg. 1997 Dec;64(6):1718-23; discussion 1723-4
references: 9436561
references: Circulation. 2008 Apr 1;117(13):1717-31
references: 18378625
references: Am J Cardiol. 2006 Aug 15;98(4):530-4
references: 16893711
references: Echocardiography. 2008 Aug;25(7):706-11
references: 18445057
references: Circ Res. 1982 Aug;51(2):196-204
references: 7094229
references: Int J Cardiol. 2007 Jan 31;115(1):86-9
references: 16750277
references: J Cardiothorac Vasc Anesth. 2005 Jun;19(3):400-2
references: 16130073
references: Anaesthesia. 2002 Jan;57(1):9-14
references: 11843735
references: J Cardiothorac Vasc Anesth. 2001 Jun;15(3):300-5
references: 11426359
references: Am J Physiol Heart Circ Physiol. 2009 Feb;296(2):H413-20
references: 19098113
references: Crit Care Med. 2002 Nov;30(11):2548-52
references: 12441768
references: J Am Coll Cardiol. 2006 Apr 4;47(7):1313-27
references: 16580516