EFFECTS OF CHRONIC RIGHT VENTRICULAR VOLUME AND PRESSURE LOADING ON LEFT VENTRICULAR PERFORMANCE
EFFECTS OF CHRONIC RIGHT VENTRICULAR VOLUME AND PRESSURE LOADING ON LEFT VENTRICULAR PERFORMANCE
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DOI：
10.1161/01.cir.44.3.403
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发表时间：
1971-01-01
期刊：
影响因子：
37.8
通讯作者：
EPSTEIN, SE
中科院分区：
文献类型：
--
作者：
KELLY, DT;SPOTNITZ, HM;EPSTEIN, SE
慢性右心室（RV）扩张对左心室（LV）功能的影响是在肺动脉周围放置收缩带和三尖瓣功能不全产生左心室压力和容量负荷3周后进行评估的。这导致腹水，右室肥大和扩张，右室舒张末压（EDP）升高，右室和左室去甲肾上腺素浓度降低。在LVEDP值为1 ~ 20 mm Hg的等体积搏动期间测量左室峰值压、壁应力和dp/dt，并比较正常、假手术和RV应激犬的匹配EDP值。在这种情况下，左室功能明显下降。在另一组狗中评估左室容积负荷对钾停搏心脏左室压力-容积曲线的影响。左室的压力-容积曲线发生了移位，使得任何给定的左室容积都与较高的左室压力相关。因此，当峰值压力和壁应力与左室舒张末期容积而不是与LVEDP相关时，两者之间的关系与正常情况没有差异；然而，峰值dp/dt和峰值VCE仍然很低。这种凹陷可能代表左室收缩能力的下降，这是由于慢性右室压力造成的，或者可能反映了左室几何形状的改变。因此，当右心室遭受慢性流量和压力负荷时，当使用收缩性指标需要测量LVEDP时，左心室功能的评估可能不可靠。
The effects of chronic right ventricular (RV) distension on left ventricular (LV) function were assessed in dogs 3 weeks after pressure and volume loading of the RV had been produced by the emplacement of a constricting band around the pulmonary artery and the creation of tricuspid insufficiency. This resulted in ascites, RV hypertrophy and dilatation, an increase in RV end-diastolic pressure (EDP), and a reduction of RV and LV norepinephrine concentrations. Peak LV pressure, wall stress, and dp/dt were measured during isovolumic beats at LVEDP's of 1 to 20 mm Hg, and comparisons at matched EDP's were made among the normal, sham-operated, and RV stressed dogs. Under these circumstances, LV function appeared to be depressed appreciably. The effects of RV volume loading on the pressure-volume curve of the LV in the potassium-arrested heart were assessed in a separate group of dogs. The pressure-volume curve of the LV was shifted so that any given LV volume was associated with a higher LV pressure. Thus, when peak pressure and wall stress were related to LV end-diastolic volume rather than to LVEDP, the relationship did not appear to differ from normal; peak dp/dt and peak VCE, however, remained depressed. This depression may represent a decrease in LV contractility consequent to the chronic RV stress or may reflect alterations in LV geometry. Thus, when the RV is subjected to a chronic flow and pressure load, assessment of LV function may be unreliable when indices of contractility are employed that require measurements of LVEDP.