Right Ventricular Failure in Idiopathic Pulmonary Arterial Hypertension Is Associated With Inefficient Myocardial Oxygen Utilization

DOI Web Site 被引用文献2件
  • Yeun Ying Wong
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Gerrina Ruiter
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Mark Lubberink
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Pieter G. Raijmakers
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Paul Knaapen
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • J. Tim Marcus
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Anco Boonstra
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Adriaan A. Lammertsma
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Nico Westerhof
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Willem J. van der Laarse
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
  • Anton Vonk-Noordegraaf
    From the Department of Pulmonology (Y.W., G.R., A.B., A.V.-N.), the Department of Physiology (Y.Y.W., G.R., A.B., N.W., W.J.v.d.L), the Department of Nuclear Medicine and PET Research (M.L., P.G.R., A.A.L.), the Department of Cardiology (P.K.), and the Department of Physics and Medical Technology (J.T.M.), Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.

説明

<jats:sec> <jats:title>Background—</jats:title> <jats:p> In idiopathic pulmonary arterial hypertension (IPAH), increased right ventricular (RV) power is required to maintain cardiac output. For this, RV O <jats:sub>2</jats:sub> consumption (MVO <jats:sub>2</jats:sub> ) must increase by augmentation of O <jats:sub>2</jats:sub> supply and/or improvement of mechanical efficiency–ratio of power output to MVO <jats:sub>2</jats:sub> . In IPAH with overt RV failure, however, there is evidence that O <jats:sub>2</jats:sub> supply (perfusion) reserve is reduced, leaving only increase in either O <jats:sub>2</jats:sub> extraction or mechanical efficiency as compensatory mechanisms. We related RV mechanical efficiency to clinical and hemodynamic parameters of RV function in patients with IPAH and associated it with glucose metabolism. </jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> The patients included were in New York Heart Association (NYHA) class II (n=8) and class III (n=8). They underwent right heart catheterization, MRI, and H <jats:sub>2</jats:sub> <jats:sup>15</jats:sup> O-, <jats:sup>15</jats:sup> O <jats:sub>2</jats:sub> -, C <jats:sup>15</jats:sup> O-, and <jats:sup>18</jats:sup> FDG-PET. RV power and O <jats:sub>2</jats:sub> supply were similar in both groups (NYHA class II versus class III: 0.54±0.14 versus 0.47±0.12 J/s and 0.109±0.022 versus 0.128±0.026 mL O <jats:sub>2</jats:sub> /min per gram, respectively). RV O <jats:sub>2</jats:sub> extraction was near-significantly lower in NYHA class II compared with NYHA class III (63±17% versus 75±16%, respectively, <jats:italic>P</jats:italic> =0.10). As a result, MVO <jats:sub>2</jats:sub> was significantly lower (0.066±0.012 versus 0.092±0.010 mL O <jats:sub>2</jats:sub> /min per gram, respectively, <jats:italic>P</jats:italic> =0.006). RV efficiency was reduced in NYHA class III (13.9±3.8%) compared with NYHA class II (27.8±7.6%, <jats:italic>P</jats:italic> =0.001). Septal bowing, measured by MRI, correlated with RV efficiency ( <jats:italic>r</jats:italic> =−0.59, <jats:italic>P</jats:italic> =0.020). No relation was found between RV efficiency and glucose uptake rate. RV mechanical efficiency and ejection fraction were closely related ( <jats:italic>r</jats:italic> =0.81, <jats:italic>P</jats:italic> <0.001). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>RV failure in IPAH was associated with reduced mechanical efficiency that was partially explained by RV mechanical dysfunction but not by a metabolic shift.</jats:p> </jats:sec>

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