Vena cava backflow and right ventricular stiffness in pulmonary arterial hypertension.

Autor:	Marcus JT; Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Westerhof BE; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Groeneveldt JA; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bogaard HJ; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Man FS; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Vonk Noordegraaf A; Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2019 Oct 17; Vol. 54 (4). Date of Electronic Publication: 2019 Oct 17 (Print Publication: 2019).
DOI:	10.1183/13993003.00625-2019
Abstrakt:	Vena cava backflow is a well-recognised clinical hallmark of right ventricular failure in pulmonary arterial hypertension (PAH). Backflow may result from tricuspid regurgitation during right ventricular systole or from impaired right ventricular diastolic filling during atrial contraction. Our aim was to quantify the forward and backward flow in the vena cava and to establish the main cause in PAH.In 62 PAH patients, cardiac magnetic resonance measurements provided volumetric flows (mL·s -1 ) in the superior and inferior vena cava; time integration of flow gave volume. The "backward fraction" was defined as the ratio of the backward and forward volumes in the vena cava, expressed as a percentage. Time of maximum vena cava backflow was expressed as a percentage of the cardiac cycle. Right ventricular volumes and aortic stroke volume were determined. Right heart catheterisation gave right ventricular and right atrial pressures. Right ventricular end-diastolic stiffness was determined with the single-beat method.The median (interquartile range) backward fraction was 12% (3-24%) and it was >20% in 21 patients. Maximum backflow occurred at near 90% of the cardiac cycle, coinciding with atrial contraction. The backward fraction was associated with maximal right atrial pressure (Spearman's r=0.77), right ventricular end-diastolic stiffness (r=0.65) and right ventricular end-diastolic pressure (r=0.77), and was negatively associated with stroke volume (r= -0.61) (all p<0.001).Significant backward flow in the vena cava was observed in a large group of PAH patients and occurred mostly during atrial contraction as a consequence of impaired right ventricular filling due to right ventricular diastolic stiffness. The backward flow due to tricuspid regurgitation was of significance in only a small minority of patients. Competing Interests: Conflict of interest: J.T. Marcus reports personal fees for consultancy from Actelion Pharmaceuticals, outside the submitted work. Conflict of interest: B.E. Westerhof reports grants from the Netherlands Organization for Scientific Research, during the conduct of the study. Conflict of interest: J.A. Groeneveldt has nothing to disclose. Conflict of interest: H.J. Bogaard has nothing to disclose. Conflict of interest: F.S. de Man has nothing to disclose. Conflict of interest: A. Vonk Noordegraaf reports personal fees for lectures from Actelion and MSD, outside the submitted work. (Copyright ©ERS 2019.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu