Longitudinal Shortening Accounts for the Majority of Right Ventricular Contraction and Improves After Pulmonary Vasodilator Therapy in Normal Subjects and Patients With Pulmonary Arterial Hypertension
Longitudinal Shortening Accounts for the Majority of Right Ventricular Contraction and Improves After Pulmonary Vasodilator Therapy in Normal Subjects and Patients With Pulmonary Arterial Hypertension
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DOI：
10.1378/chest.10-1136
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发表时间：
2011-07-01
期刊：
影响因子：
9.6
通讯作者：
Forfia, Paul R.
中科院分区：
文献类型：
--
作者：
Brown, Suzanne B.;Raina, Amresh;Forfia, Paul R.
背景：右心室具有独特的收缩模式，大部分缩短发生在纵向平面。然而，纵向和横向缩短的相对贡献，整体右心室（RV）功能尚未量化。我们试图量化的比例，纵向和横向缩短RV功能正常人和肺动脉高压（PAM）患者在基线和以下PAM-specific therapeutic.Methods：正常队列包括90例正常的临床超声心动图，而PAM队列包括36例患者，其中25例超声心动图之前和之后开始PAM-specific therapy。结果：正常人右心室纵向面积变化分数（LFAC）占总RVFAC的77% ± 14%，其中纵向面积变化分数（LFAC）占总RVFAC的77% ± 14%。在PAM患者中，纵向缩短仍然代表了RVFAC的大部分，即使它低于正常受试者（63% ± 18%，P <0.0001）。PAH治疗后，总体RV功能改善（RVFAC，30% +/- 13%至36% +/- 9%; P = 0.026），仅因为纵向面积变化增加。因此，纵向缩短的比例增加（LFAC，58% +/- 18%至69% +/- 17%; P = 0.002），而横向短缩下降（横向面积变化分数，42% +/- 18% vs 31% +/- 17%; P = .002）。在正常受试者和PAH患者中，纵向缩短占RV收缩的大部分，尽管在PAH中较少。肺血管扩张剂治疗后RV功能的改善仅来自纵向收缩的改善，这表明纵向缩短可能代表RV功能恢复的后负荷响应元素。胸部2011; 140（1）：27-33
Background: The right ventricle has a unique contraction pattern, with a greater portion of the shortening occurring in the longitudinal plane. However, the relative contributions of longitudinal and transverse shortening to overall right ventricular (RV) function have not been quantified. We sought to quantify the proportions of longitudinal and transverse shortening to RV function in normal subjects and in patients with pulmonary arterial hypertension (PAM) at baseline and following PAM-specific therapy.Methods: The normal cohort comprised 90 subjects with normal clinical echocardiograms, whereas the PAM cohort included 36 patients, of whom 25 had echocardiograms before and after initiation of PAM-specific therapy. Assessment of RV function included tricuspid annular plane systolic excursion, RV fractional area change (RVFAC), and relative change in RV area in longitudinal and transverse planes.Results: Longitudinal fractional area change (LFAC) accounted for the majority of total RVFAC (77% +/- 14%) in normal subjects. Among patients with PAM, longitudinal shortening still represented the majority of RVFAC, even though it was less than in normal subjects (63% +/- 18%, P < .0001). Following PAH therapy, overall RV function improved (RVFAC, 30% +/- 13% to 36% +/- 9%; P = .026), solely because of an increase in longitudinal area change. As a result, the proportion of longitudinal shortening increased (LFAC, 58% +/- 18% to 69% +/- 17%; P = .002), whereas transverse shortening fell (transverse fractional area change, 42% +/- 18% vs 31% +/- 17%; P = .002).Conclusions: Longitudinal shortening accounts for the majority of RV contraction in normal subjects and patients with PAH, although less so in PAH. Improved RV function following pulmonary vasodilator therapy occurs solely from improvements in longitudinal contraction, suggesting that longitudinal shortening may represent the afterload-responsive element of RV functional recovery. CHEST 2011; 140(1):27-33