End-systolic and end-diastolic ventricular interaction

1986 ◽  
Vol 251 (5) ◽  
pp. H1062-H1075 ◽  
Author(s):  
B. K. Slinker ◽  
S. A. Glantz
Keyword(s):  
Right Ventricular ◽  
Interventricular Septum ◽  
Systolic Pressure ◽  
Direct Interaction ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Physiological Mechanisms ◽  
In Series ◽  
The Right ◽  
Transient And Steady State

Right ventricular volume affects left ventricular volume via direct interaction across the interventricular septum and series interaction because the right and left hearts are connected in series through the lungs. Because it is difficult to sort out complex physiological mechanisms in the intact circulation, the relative importance of these two effects is unknown. We used statistical analyses of transient changes in left and right ventricular pressures and dimensions following pulmonary artery and venae caval constrictions to separate and quantitate the direct (immediate) from the series (delayed) interaction effects on left ventricular size at end systole and end diastole. With the pericardium closed, direct interaction was one-half as important as series interaction at end diastole and was one-third as important at end systole. With the pericardium removed, direct interaction was one-fifth as important as series interaction at end diastole and one-sixth as important at end systole. These results suggest that differences between transient and steady-state end-systolic pressure-volume relationships are largely explained by direct interaction and that direct end-systolic interaction is important for maintaining balanced right and left heart outputs.

Left-to-right systolic ventricular interaction in patients undergoing biventricular stimulation for dilated cardiomyopathy

2010 ◽  
Vol 109 (2) ◽  
pp. 418-423 ◽  
Author(s):  
Giuseppe Osculati ◽  
Gabriella Malfatto ◽  
Roberto Chianca ◽  
Giovanni B. Perego
Keyword(s):  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Biventricular Pacing ◽  
Interventricular Septum ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Data Set ◽  
Ventricular Interaction ◽  
Left And Right ◽  
The Right

Left-to-right systolic ventricular interaction (i.e., the phenomenon by which the left ventricle contributes to most of the flow and to two-thirds of the pressure generated by the right ventricle) originates from transmission of systolic forces between the ventricles through the interventricular septum and from the mechanical effect of the common muscle fibers encircling their free walls. As a consequence, any reduction of left ventricular free wall function translates in lower right ventricular pressure or function. We investigated whether systolic ventricular interaction could be evidenced in nine patients with dilated cardiomyopathy in whom a biventricular pacemaker was implanted. Changes in right and left ventricular pressures were measured with high-fidelity catheters, before and after periods of biventricular pacing from the right atrium with different stimulation intervals to the right and left ventricles, respectively. The steady-state changes of left and right ventricular systolic pressure obtained from any single pacing interval combination were considered. We then calculated, with a two-level mixed regression analysis of the entire data set, the relation between changes in left and right systolic pressures: the presence of a statistically significant slope was assumed as evidence of ventricular interaction. The slope of the regression replaced the crude pressure ratio as an estimate of the gain of the interaction; its value compared with values observed in experimental studies. Moreover, its dependence on septal elastance and on right ventricular volume was similar to that already demonstrated for ventricular interaction gain. In conclusion, the linear relationship we found between systolic pressure changes in the two ventricles of patients with dilated cardiomyopathy during biventricular pacing could be explained in terms of ventricular interaction.

scholarly journals Heart in Acromegaly: The Echocardiographic Characteristics of Patients Diagnosed with Acromegaly in Various Stages of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Agata Popielarz-Grygalewicz ◽  
Jakub S. Gąsior ◽  
Aleksandra Konwicka ◽  
Paweł Grygalewicz ◽  
Maria Stelmachowska-Banaś ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Healthy Volunteers ◽  
Global Longitudinal Strain ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
Glucose Metabolism Disorders ◽  
Acromegalic Cardiomyopathy ◽  
The Right

To determine whether the echocardiographic presentation allows for diagnosis of acromegalic cardiomyopathy. 140 patients with acromegaly underwent echocardiography as part of routine diagnostics. The results were compared with the control group comprising of 52 age- and sex-matched healthy volunteers. Patients with acromegaly presented with higher BMI, prevalence of arterial hypertension, and glucose metabolism disorders (i.e., diabetes and/or prediabetes). In patients with acromegaly, the following findings were detected: increased left atrial volume index, increased interventricular septum thickness, increased posterior wall thickness, and increased left ventricular mass index, accompanied by reduced diastolic function measured by the following parameters: E’med., E/E’, and E/A. Additionally, they presented with abnormal right ventricular systolic pressure. All patients had normal systolic function measured by ejection fraction. However, the values of global longitudinal strain were slightly lower in patients than in the control group; the difference was statistically significant. There were no statistically significant differences in the size of the right and left ventricle, thickness of the right ventricular free wall, and indexed diameter of the ascending aorta between patients with acromegaly and healthy volunteers. None of 140 patients presented systolic dysfunction, which is the last phase of the so-called acromegalic cardiomyopathy. Some abnormal echocardiographic parameters found in acromegalic patients may be caused by concomitant diseases and not elevated levels of GH or IGF-1 alone. The potential role of demographic parameters like age, sex, and/or BMI requires further research.

Direct diastolic ventricular interaction gain measured with sudden hemodynamic transients

1989 ◽  
Vol 256 (2) ◽  
pp. H567-H573 ◽  
Author(s):  
B. K. Slinker ◽  
Y. Goto ◽  
M. M. LeWinter
Keyword(s):  
Confidence Interval ◽  
Right Ventricular ◽  
Diastolic Pressure ◽  
Direct Interaction ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Base Line ◽  
Right Ventricular Volume ◽  
Ventricular Interaction ◽  
Venae Cavae

Changes in right ventricular volume affect left ventricular function via direct ventricular interaction mediated by the septum, common myocardial fibers in the free wall, and the pericardium, and also via series interaction mediated by changes in right ventricular output reaching the left ventricle through the pulmonary circulation. To study direct interaction, series interaction must be held constant or removed from the experimental preparation. Because there has been no way to directly measure direct ventricular interaction in the intact circulation, we developed a new method to experimentally separate these two components of ventricular interaction by combining abrupt occlusion of both venae cavae and quick withdrawal of 10-15 ml of blood from the right ventricle. This procedure decreased right ventricular end-diastolic pressure (RVEDP) on the next beat without changing pulmonary venous flow, left ventricular end-diastolic segment lengths, or left ventricular systolic function. The direct interaction gains, quantified as delta LVEDP/delta RVEDP, where LVEDP is left ventricular end-diastolic pressure, and delta refers to the change between the beats before and after reducing right ventricular volume, were (means +/- SD) 0.32 +/- 0.32 at steady-state LVEDP = 5 mmHg, 0.38 +/- 0.23 at LVEDP = 10 mmHg, and 0.28 +/- 0.32 at LVEDP = 15 mmHg. These gains were not significantly different (P greater than 0.50). Therefore, we calculated an overall average gain by pooling data from the three base-line LVEDP conditions. This value is 0.33 with 95% confidence interval 0.16-0.51. This 95% confidence interval indicates our data are consistent with many previous reports of diastolic direct interaction.

End-systolic pressure length relations of stunned right and left ventricles after inotropic stimulation

1993 ◽  
Vol 265 (6) ◽  
pp. H2099-H2109 ◽  
Author(s):  
R. Krams ◽  
L. K. Soei ◽  
E. O. McFalls ◽  
E. A. Winkler Prins ◽  
L. M. Sassen ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Segment Length ◽  
Atrial Pacing ◽  
Regression Equations ◽  
External Work ◽  
Left And Right ◽  
The Right

Regional end-systolic pressure-segment length relationships (ESPSLR) were used to compare the degree of right and left ventricular stunning induced by a 10-min occlusion of the left anterior descending coronary artery and the response to subsequent atrial pacing (50 beats/min above intrinsic heart rate) without and with dobutamine (2 micrograms.kg-1.min-1) in nine anesthetized open-chest pigs. From the ESPSLR, the slope (Ees) (at 100 mmHg for the left and 25 mmHg for the right ventricle) and the total area of the pressure-length relationship (PLA) were determined. From the latter, the distribution into external work (EW) and potential energy (PE) as well as the efficiency of energy transfer (EET = EW/PLA) were calculated. In both the stunned left and right ventricular myocardium Ees and EW were reduced according to the same linear regression equations (delta Ees = 0.7 Ees,baseline - 11.4, r2 = 0.86 and delta EW = 0.4 EWbaseline + 2.3, r2 = 0.67), where Ees,baseline and EWbaseline are Ees and EW at baseline, respectively. EET of the stunned left and right ventricular segments decreased as PLA remained unchanged, due to an increase in PE. EET decreased from 0.84 +/- 0.02 to 0.71 +/- 0.03 (P < 0.05) in the stunned right ventricular segment and from 0.71 +/- 0.02 to 0.44 +/- 0.03 (P < 0.05) in the stunned left ventricular segment. Atrial pacing did not affect EET with respect to stunning levels, whereas the additional infusion of dobutamine restored Ees, EW, and PE and consequently EET to baseline values. In conclusion, the right ventricle is susceptible to stunning. During atrial pacing the EET was lower than expected from the Ees, which could, in agreement with the time-varying elastance concept, be explained by an increase in afterload (a consequence of the decrease in stroke volume). Dobutamine not only increased Ees, EW, and EET but also restored the relationship between Ees and EET in both ventricular stunned segments.

scholarly journals 108 Uncommon cardiac fatty distribution: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Redondo Bermejo ◽  
M M De La Torre Carpente ◽  
J C Munoz San Jose ◽  
T Escudero Caro ◽  
M Acuna Lorenzo ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Rare Case ◽  
Interventricular Septum ◽  
Fatty Infiltration ◽  
Left Ventricular ◽  
Pericardial Fat ◽  
Cardiac Apex ◽  
The Right

Abstract Background Fatty masses of the heart are relatively uncommon. This report is about a rare case of extensive fat infiltration along the apical interventricular septum that causes separation of the right ventricular apex from left ventricular apex, simulating a bifid cardiac apex. Case summary The patient was a 58-year-old female who was admitted to the hospital because of palpitations and chest pain. A trasnsthoracic echocardiogram was performed and it showed a thickenned anterior pericardium so a cardiovascular magnetic resonance (CMR) was performed. CMR revealed a large amount of epicardial and pericardial fat without adipose tissue inside the right ventricle wall. In the cardiac apex this fat seemed a lipoma however CMR demonstrated the fat was not capsulated and besides, it extended, as if it were an infiltrative disorder, in the cardiac apex between both ventricles. Patient was discharged with an implantable loop recorder (ILR) in order to ruled out ventricular arrhythmia. During a two year follow-up, ILR has shown several symptomatic supraventricular paroxysmal tachycardia episodes and no other arrhythmic events have been reported. Also, the CMR has been repeated and it has shown similar results. Discussion Fatty masses of the heart are relatively uncommon. Among those masses are included cardiac lipomas, lipomatous infiltration of the right ventricle, arrhythmogenic right ventricular dysplasia (ARVD) and lipomatous hypertrophy of the interatrial septum. The findings in the CMR of our patient do not fulfill the criteria of the aforementioned disorders. Our patient shows a pattern of unusual fatty infiltration pattern of unclear etiology. The prognostic value of this type of heart disease is unknown. In our patient, although the follow-up has not been very long, it does not seem to have had any relevant consequences, so far. Conclusion This is a rare case of a patient with a large amount of epicardial and pericardial fat that seems to infiltrate between both ventricular apex, as a bifid cardiac apex. It is apparently asymptomatic. Abstract 108 Figure. CMR-Cardiac-fatty_EECHO-2019

Measurement of left and right ventricular volume from implanted radiopaque markers

1981 ◽  
Vol 240 (6) ◽  
pp. H896-H900
Author(s):  
W. P. Santamore ◽  
R. Carey ◽  
D. Goodrich ◽  
A. A. Bove
Keyword(s):  
Standard Deviation ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Ventricular Volumes ◽  
Radiopaque Markers ◽  
Left And Right ◽  
The Right

To better understand biventricular mechanics, an algorithm was developed to simultaneously calculate right and left ventricular volumes from randomly placed subendocardial radiopaque markers. Mathematically, the ventricle is represented as a stack of circular discs. The radius R of each disc is calculated as the distance from the subendocardial radiopaque marker to a computer generated base-to-apex line, and the height H of each disc is determined by the projected distance between radiopaque markers along the base-to-apex line. Accordingly, the volume (V) is calculated as V = pi . sigma Hi . Ri2. The validity of this algorithm was tested on 10 canine left ventricular casts, on 10 human right ventricular casts, and in five experiments. For the left ventricle, the regression line between the casts (VT) and calculated (VC) volumes was VC = 0.55 VT + 6.6, with r = 0.95, standard error of estimate (Sy) = 1.9 ml, and the standard deviation of percent error = 12.6%. For the right ventricle, VC = 1.75 VT = 42.5, with r = 0.86, Sy = 16.2 ml, and the standard deviation of percent error = 24.8%. In five animal experiments, radiopaque markers were implanted into the endocardium of the left and right ventricles and comparisons were made between angiographic- and marker-determined ventricular volumes. For the five experiments, the mean correlation coefficient, relating the marker volumes to the angiographic volumes, were 0.92 +/- 0.01 for the left ventricle and 0.89 +/- 0.02 for the right ventricle. The results, which are similar to other volume-determination methods, indicate that this method can be applied to determine right and left ventricular volume. Once implanted, fluoroscopy of these markers provides a noninvasive means of calculating ventricular volume.

Pulmonary atresia with intact ventricular septum and antenatal left ventricular failure

2004 ◽  
Vol 14 (3) ◽  
pp. 335-337 ◽  
Author(s):  
Saad Khoshhal ◽  
George G. S. Sandor ◽  
Walter J. Duncan
Keyword(s):  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Pulmonary Atresia ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Ventricular Failure ◽  
Severe Left Ventricular Dysfunction ◽  
The Right

Pulmonary atresia with intact ventricular septum has been described extensively, and it is recognized that associated abnormalities of the coronary arteries may cause ischemia. We describe a fetus, diagnosed antenatally as having pulmonary atresia with intact ventricular septum and severe hypoplasia of the right ventricle, who developed severe left ventricular dysfunction. We hypothesize that this is due to reduced coronary blood flow because of falling right ventricular volume in the presence of complete right ventricular coronary arterial dependence.

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