Preserved right ventricular function but increased right atrial contractile demand in altitude-induced pulmonary hypertension.
- 作者列表："Sareban M","Perz T","Macholz F","Reich B","Schmidt P","Fried S","Mairbäurl H","Berger MM","Niebauer J
PURPOSE:Ascent to high altitude increases right ventricular (RV) afterload and decreases myocardial energy supply. This study evaluates physiologic variables and comprehensive echocardiographic indices of RV and right atrial (RA) function following rapid ascent to high altitude. METHODS:Fifty healthy volunteers actively ascended from 1130 to 4559 m in < 22 h. All participants underwent 2D echocardiography during baseline examination at low altitude (424 m) and at three study time-points (7, 20 and 44 h) after arrival at high altitude. In addition to systolic pulmonary artery pressure (sPAP), comprehensive 2D planimetric-, tissue Doppler- and speckle-tracking-derived strain indices of RA and RV function were obtained. RESULTS:sPAP increased from baseline (24 ± 4 mmHg) to the first altitude examination (39 ± 8 mmHg, p < 0.001) and remained elevated during the following 44 h. Global RV function did not change. RA reservoir strain showed a trend towards increase from baseline (50.2 ± 12.1%) to the first altitude examination (53.8 ± 11.0%, p = 0.07) secondary to a significant increase of RA contraction strain (19.2 ± 6.4 vs. 25.4 ± 9.6%, p < 0.001). Volumetric RA data largely paralleled RA strain results and RA active emptying volume was increased throughout the 44 h stay at high altitude. CONCLUSION:Active and rapid ascent of healthy individuals to 4559 m is associated with an increased contractile performance of the RA that compensates for the increased workload of the RV.
目的: 上升到高海拔增加右心室后负荷，降低心肌能量供应。本研究评估了快速上升到高原后RV和右心房 (RA) 功能的生理变量和综合超声心动图指标。 方法: 50名健康志愿者在 <22小时内从1130米上升到4559米。所有参与者在低海拔 (424米) 基线检查期间和到达高海拔后的三个研究时间点 (7、20和44小时) 进行二维超声心动图检查。除肺动脉收缩压 (sPAP) 外，还获得了全面的二维平面测量、组织多普勒和斑点追踪衍生的RA应变指数和RV功能指数。 结果: sPAP从基线 (24 ± 4 mmHg) 增加到第一次高原检查 (39 ± 8 mmHg，p <0.001)，并在随后的44小时内保持升高。全局RV功能没有改变。RA储层应变显示出从基线 (50.2 ± 12.1%) 到第一次海拔检查 (53.8 ± 11.0%，p = 0.07) 的增加趋势，继发于RA收缩应变的显著增加 (19.2 ± 6.4 vs. 25.4 ± 9.6%，p <0.001)。体积RA数据在很大程度上与RA应变结果平行，RA主动排空体积在高海拔停留44小时内增加。 结论: 健康个体的积极和快速上升到4559 m与RA的收缩性能增加相关，这补偿了RV的增加的工作负荷。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.