Heart Rate Dependence of the Pulmonary Resistance x Compliance (RC) Time and Impact on Right Ventricular Load
Heart Rate Dependence of the Pulmonary Resistance x Compliance (RC) Time and Impact on Right Ventricular Load
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DOI：
10.1371/journal.pone.0166463
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发表时间：
2016-11-18
期刊：
影响因子：
3.7
通讯作者：
Tedford, Ryan J.
中科院分区：
文献类型：
--
作者：
Metkus, Thomas S.;Mullin, Christopher J.;Tedford, Ryan J.
背景心率 (HR) 和体表面积 (BSA) 对肺 RC 时间和右心室 (RV) 负荷的影响尚不清楚。方法为了确定 HR 和 BSA 与肺 RC 时间和 RV 负荷测量值之间的关系，我们研究了三个大型患者队列，包括 1) 已知或疑似肺动脉高压 (PAH) (n = 1008)、2) 左心疾病引起的肺动脉高压 (n = 468) 和 3)射血分数降低的终末期心力衰竭 (n = 150)。为了在个体患者水平上证实这些关联，我们使用高保真导管对 22 名接受右心房起搏的 PAH 患者进行了额外分析。结果更快的 HR 与 RC 时间呈负相关（所有患者的 p < 0.01），表明 RV 脉动负荷增强。较低的 BSA 与 RC 时间直接相关 (p< 0.05)，尽管这种影响的幅度小于 HR。随着心房起搏的增加，心输出量增加，总肺阻力（TPR）下降。然而，有效动脉弹性、其平均阻力成分（TPR/心率；0.60 +/- 0.27 与 0.79 +/- 0.45；p = 0.048）及其搏动成分（0.27 +/- 0.18 与 0.39 +/- 0.28；p = 0.03）均在心率加快时增加。 结论 心率和 BSA 相关与肺RC时间。随着心率增加，RV 上的脉动负荷和总负荷也会增加。这种关系支持了心动过速对右心室不利影响的血流动力学机制。
BackgroundThe effect of heart rate (HR) and body surface area (BSA) on pulmonary RC time and right ventricular (RV) load is unknown.MethodsTo determine the association of HR and BSA with the pulmonary RC time and measures of RV load, we studied three large patient cohorts including subjects with 1) known or suspected pulmonary arterial hypertension (PAH) (n = 1008), 2) pulmonary hypertension due to left heart disease (n = 468), and 3) end-stage heart failure with reduced ejection fraction (n = 150). To corroborate these associations on an individual patient level, we performed an additional analysis using high-fidelity catheters in 22 patients with PAH undergoing right atrial pacing.ResultsA faster HR inversely correlated with RC time (p< 0.01 for all), suggesting augmented RV pulsatile loading. Lower BSA directly correlated with RC time (p< 0.05) although the magnitude of this effect was smaller than for HR. With incremental atrial pacing, cardiac output increased and total pulmonary resistance (TPR) fell. However, effective arterial elastance, its mean resistive component (TPR/heart period; 0.60 +/- 0.27 vs. 0.79 +/- 0.45; p = 0.048), and its pulsatile component (0.27 +/- 0.18 vs 0.39 +/- 0.28; p = 0.03) all increased at faster HR.ConclusionHeart rate and BSA are associated with pulmonary RC time. As heart rate increases, the pulsatile and total load on the RV also increase. This relationship supports a hemodynamic mechanism for adverse effects of tachycardia on the RV.