Hemodynamic alterations during septal or right ventricular ischemia in dogs

doi:10.1016/S0002-8703(77)80313-X

American Heart Journal

Volume 93, Issue 2, February 1977, Pages 210-215

https://doi.org/10.1016/S0002-8703(77)80313-X Get rights and content

Summary

This study indicates that in dogs, ischemic injury to just the ventricular septum has little effect on left ventricular function. The data demonstrate that ischemic injury to either the right ventricular free wall or the ventricular septum alters right ventricular function and/or compliance, suggesting that both regions play a role in maintaining right ventricular performance. That septal contraction supports right ventricular function may explain why in earlier studies, right ventricular pressure development and output were little affected by severe injury to the free wall.

References (15)

FixlerD.E. et al.
Effects of acute right ventricular systolic hypertension on regional myocardial blood flow in anesthetized dogs
Am. Heart J.
(1973)
StarrI. et al.
The absence of conspicuous increments in venous pressure after severe damage to the right ventricle of the dog with a discussion of the relation between clinical congestive failure and heart disease
Am. Heart J.
(1943)
KaganA.
Dynamic responses of the right ventricle following extensive damage by cauterization
Circulation
(1952)
BakosA.C.P.
The question of the function of the right ventricular myocardium: An experimental study
Circulation
(1950)
BrooksH. et al.
Performance of the right ventricle under stress: relation to right coronary flow
J. Clin. Invest.
(1971)
FixlerD.E. et al.
Regional coronary flow with increased right ventricular output in anesthetized dogs
Am. Heart J.
(1973)
MonroeG.A. et al.
Effect of acute pulmonary arterial obstruction on right ventricular volume and coronary flow in closed chest, anesthetized dogs
Circulation
(1973)

There are more references available in the full text version of this article.

Cited by (45)

The interventricular septum in pulmonary hypertension does not show features of right ventricular failure
2014, International Journal of Cardiology
Right ventricular function in patients with different infarction sites after a first acute myocardial infarction
2011, American Journal of the Medical Sciences
Citation Excerpt :
However, the actual mechanism(s) behind the above differences of RV performance in these patients could not be elucidated in this study. Although interventricular septal motion was found to be closely related to the RV function in previous studies11,14–16,30 and our results in univariate analysis, it was not an independent correlate of RV MPI in multivariate analysis in our study. The close correlation of the RV MPI with the LV MPI implicates that the ventricular interdependence perhaps plays a role for the discrepancy of RV performance in patients with different infarct locations, but it seems unlikely to be the entire explanation for our observations because only the RV MPI but not the RV diastolic parameter, ie, the tricuspid E/Em ratio, showed independent correlation with LV functional parameters.
To investigate the effect of different infarction sites on right ventricular (RV) functional changes in patients with a first acute ST-elevation myocardial infarction without concomitant RV infarction.
Sixty consecutive patients underwent conventional echocardiography and pulsed-wave tissue Doppler imaging for RV function evaluation after successful primary percutaneous coronary intervention. They were divided into 2 groups according to infarct location based on the electrocardiographic findings: group I consisted of 35 patients with anterior (including anteroseptal) wall infarction and group II included 25 patients with inferior (including inferoposterior) wall infarction. Ten healthy individuals served as the control group.
The tricuspid annular plane systolic excursion was significantly lower in group I compared with that in the controls (20.3 ± 3.8 versus 23.9 ± 2.4 mm, P < 0.05). The ratio of transtricuspid peak early filling velocity to tricuspid annular early diastolic velocity (E/E_m) was comparable between group I and group II, whereas it was higher in group II than in the controls (6.10 ± 1.37 versus 4.33 ± 1.17, P < 0.05). The RV myocardial performance index determined by tissue Doppler imaging was significantly higher in group I than in group II (0.48 ± 0.25 versus 0.32 ± 0.10, P < 0.05) and the healthy controls (0.48 ± 0.25 versus 0.27 ± 0.08, P < 0.05).
In patients with a first, acute reperfused ST-elevation myocardial infarction without associated RV infarction, RV function may be affected discrepantly depending on the different infarction sites. In patients with inferior infarction without concomitant RV infarction, only regional RV diastolic dysfunction is observed, whereas the alteration of global RV function is more pronounced in patients with anterior wall infarction.
Intracardiac ultrasound detection of right ventricular infarction in a canine model
1997, Journal of the American Society of Echocardiography
Our objective was to demonstrate that right ventricular (RV) infarction could be demonstrated by intracardiac ultrasonography in a canine model. RV infarction is a common and important clinical condition in patients with myocardial infarction. Traditional methods for diagnosing RV infarction have limitations. Intracardiac echocardiography, in which an ultrasonic transducer on the tip of a catheter is placed intravenously into the RV chamber, should allow detection of RV infarction. Nine closed-chest dogs were studied. The animals were instrumented with a 10 MHz ultrasound catheter placed into the right ventricle. The right coronary artery was occluded with a balloon angioplasty catheter for 20 minutes and subsequently embolized with elemental mercury. Intracardiac ultrasound images were obtained at baseline, during balloon occlusion, and during embolization. RV cross-sectional end-diastolic and end-systolic areas were calculated and fractional area change were calculated; RV wall motion abnormalities were also evaluated. The interventricular septal thickening was also calculated. The 10 MHz intracardiac ultrasound catheter allowed visualization of much of the RV chamber and interventricular septum. The RV cross-sectional area increased with mercury embolization, which was also associated with regional wall motion abnormalities. RV end-systolic area was 1.6 cm² and end-diastolic area 3.9 cm² at baseline; these increased to 4.8 cm² and 6.5 cm² after embolization (p <0.05). Interventricular septal thickening remained unchanged. The echocardiographic features of RV infarction, which include RV dilation and RV regional wall motion abnormalities, could be demonstrated in a canine infarct model with a 10 MHz intracardiac ultrasound catheter. (J Am Soc Echocardiogr 1997;10:352-6.)
Right ventricular blood flow during left ventricular support in an experimental porcine model
1996, Annals of Thoracic Surgery
Right ventricular blood flow may be adversely affected during left ventricular assist device (LVAD) use leading to right ventricular (RV) ischemia and RV dysfunction. This study characterized normal RV blood flow responses to LVAD operation.
Seven Yorkshire pigs weighing 74.4 ± 3.4 kg underwent right coronary artery blood flow measurements with an ultrasonic flow probe and injection of radiolabeled microspheres. A Thoratec LVAD was used in either synchronous or asynchronous modes and RV loading was increased using a pulmonary artery snare.
The RV blood flow was compared between three regions that differed in proximity to the right coronary artery: proximal segment, mid-RV, and distal. The right ventricular distal flows was 0.93 ± 0.07 mL · min⁻¹ · g⁻¹ compared with 0.74 ± 0.06 mL · min⁻¹ · g⁻¹ at right ventricular proximal flow during control measurements (p = 0.0001). This difference was maintained during LVAD operation in either synchronous or asynchronous modes and also during pulmonary artery constriction.
Global RV flow is not adversely affected by LVAD use. A flow gradient occurs along the right coronary artery with the distal vascular bed having relatively less reserve, which may be more susceptible to ischemia in patients with preexisting coronary disease or RV distention during LVAD use.
Jugular venous pressure and pulse wave form in the diagnosis of right ventricular infarction
1996, International Journal of Cardiology
Jugular venous pressure (measured clinically) and pulse wave form (recorded at 100 mm/s) were analysed in 44 cases of first acute myocardial infarction and 10 age-matched controls. Patients were divided into different groups according to site of infarction decided by detailed 2-D echocardiography. Raised jugular venous pressure had high specificity (96.8%) but low sensitivity (39%) in diagnosing right ventricular infarction. Positive Kussmaul's sign had equal specificity but lower sensitivity (26.1%). Rapid ‘y’ descent had high specificity (100%) but low sensitivity (17.3%) in diagnosing right ventricular infarction. Jugular venous pressure and pulse wave form are significantly affected by the magnitude of damage to interventricular septum and left ventricular free wall.
Relationship between hemodynamics and right ventricular function in patients with cardiomyopathy: Important role of tricuspid regurgitation
1995, Chest
Right ventricular (RV) ejection fraction is load sensitive, varying inversely with pulmonary artery pressure. We tested whether this relationship exists in dilated cardiomyopathy.
Retrospective chart review.
Tertiary care referral medical center.
In 25 patients with cardiomyopathy referred for heart transplant evaluation (left ventricular ejection fraction 27±12%), hemodynamics, radionuclide angiograms, and Doppler echocardiograms were obtained initially (study A) and 8±8 months later (study B).
Right ventricular ejection fraction was 40±17% on study A and 41±16% on study B, with a wide range of change between studies (+38 to −28%). Pulmonary artery systolic pressure (PASP) and right atrial pressure increased (52±9 to 61±10 mm Hg and 10±4 to 14±4 mm Hg, respectively, p<0.05). There was no relation between PASP and RV ejection fraction (n=50, r=-0.02, p=0.87). Also, there was no relation between changes in PASP and RV ejection fraction (n=25, r=0.25, p=0.15) between study A and B. However, there was a significant relation between interstudy changes in PASP and RV ejection fraction (n=14, r=-0.7l, p=0.005) and end-systolic volume (n=14, r=0.53, p<0.05) in patients in whom the degree of tricuspid regurgitation was either none or mild on both study A and B.
In patients with cardiomyopathy, RV ejection fraction cannot be used as a noninvasive marker of pulmonary hypertension. Owing to variation in tricuspid regurgitation, alterations in pulmonary artery pressure over time may not lead to the expected change in RV ejection fraction or end-systolic volume.

View all citing articles on Scopus

^†: This study was supported by a grant from the American Heart Association, Texas Affiliate, Inc.

¹: From the Department of Pediatrics, The University of Texas Health Science Center at Dallas, Southwestern Medical School, Dallas, Texas.

View full text

Hemodynamic alterations during septal or right ventricular ischemia in dogs†

Summary

Effects of acute right ventricular systolic hypertension on regional myocardial blood flow in anesthetized dogs

Am. Heart J.

The absence of conspicuous increments in venous pressure after severe damage to the right ventricle of the dog with a discussion of the relation between clinical congestive failure and heart disease

Am. Heart J.

Dynamic responses of the right ventricle following extensive damage by cauterization

Circulation

The question of the function of the right ventricular myocardium: An experimental study

Circulation

Performance of the right ventricle under stress: relation to right coronary flow

J. Clin. Invest.

Regional coronary flow with increased right ventricular output in anesthetized dogs

Am. Heart J.

Effect of acute pulmonary arterial obstruction on right ventricular volume and coronary flow in closed chest, anesthetized dogs

Circulation