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J Am Coll Cardiol. 2017 Jan 17;69(2):236-243. doi: 10.1016/j.jacc.2016.10.047.

The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension.

Author information

1
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: a.vonk@vumc.nl.
2
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands; Laboratory for Clinical Cardiovascular Physiology, Center for Heart Failure Research, Academic Medical Center, Amsterdam, the Netherlands.
3
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands.

Abstract

In pulmonary hypertension, the right ventricle adapts to the increasing vascular load by enhancing contractility ("coupling") to maintain flow. Ventriculoarterial coupling implies that stroke volume changes little while preserving ventricular efficiency. Ultimately, a phase develops where ventricular dilation occurs in an attempt to limit the reduction in stroke volume, with uncoupling and increased wall stress as a consequence. With pressure-volume analysis, we separately describe the changing properties of the pulmonary vascular system and the right ventricle, as well as their coupling, as important concepts for understanding the changes that occur in pulmonary hypertension. On the basis of the unique properties of the pulmonary circulation, we show how all relevant physiological parameters can be derived using an integrative approach. Because coupling is maintained by hypertrophy until the end stage of the disease, when progressive dilation begins, right ventricular volume is the essential parameter to measure in follow-up of patients with pulmonary hypertension.

KEYWORDS:

compliance-resistance relation; pulmonary arterial system; right heart failure; ventriculoarterial coupling

PMID:
28081831
DOI:
10.1016/j.jacc.2016.10.047
[Indexed for MEDLINE]
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