TY - JOUR
T1 - Heart rate dependence of the pulmonary resistance x compliance (rc) time and impact on right ventricular load
AU - Metkus, Thomas S.
AU - Mullin, Christopher J.
AU - Grandin, E. Wilson
AU - Rame, J. Eduardo
AU - Tampakakis, Emmanouil
AU - Hsu, Steven
AU - Kolb, Todd M.
AU - Damico, Rachel
AU - Hassoun, Paul M.
AU - Kass, David A.
AU - Mathai, Stephen C.
AU - Tedford, Ryan J.
N1 - Publisher Copyright:
© 2016 Metkus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/11
Y1 - 2016/11
N2 - Background The effect of heart rate (HR) and body surface area (BSA) on pulmonary RC time and right ventricular (RV) load is unknown. Methods To determine the association of HR and BSA with the pulmonary RC time and measures of RV load, we studied three large patient cohorts including subjects with 1) known or suspected pulmonary arterial hypertension (PAH) (n = 1008), 2) pulmonary hypertension due to left heart disease (n = 468), and 3) end-stage heart failure with reduced ejection fraction (n = 150). To corroborate these associations on an individual patient level, we performed an additional analysis using high-fidelity catheters in 22 patients with PAH undergoing right atrial pacing. Results A faster HR inversely correlated with RC time (p<0.01 for all), suggesting augmented RV pulsatile loading. Lower BSA directly correlated with RC time (p<0.05) although the magnitude of this effect was smaller than for HR. With incremental atrial pacing, cardiac output increased and total pulmonary resistance (TPR) fell. However, effective arterial elastance, its mean resistive component (TPR/heart period; 0.60-0.27 vs. 0.79-0.45;p = 0.048), and its pulsatile component (0.27-0.18 vs 0.39-0.28;p = 0.03) all increased at faster HR. Conclusion Heart rate and BSA are associated with pulmonary RC time. As heart rate increases, the pulsatile and total load on the RV also increase. This relationship supports a hemodynamic mechanism for adverse effects of tachycardia on the RV.
AB - Background The effect of heart rate (HR) and body surface area (BSA) on pulmonary RC time and right ventricular (RV) load is unknown. Methods To determine the association of HR and BSA with the pulmonary RC time and measures of RV load, we studied three large patient cohorts including subjects with 1) known or suspected pulmonary arterial hypertension (PAH) (n = 1008), 2) pulmonary hypertension due to left heart disease (n = 468), and 3) end-stage heart failure with reduced ejection fraction (n = 150). To corroborate these associations on an individual patient level, we performed an additional analysis using high-fidelity catheters in 22 patients with PAH undergoing right atrial pacing. Results A faster HR inversely correlated with RC time (p<0.01 for all), suggesting augmented RV pulsatile loading. Lower BSA directly correlated with RC time (p<0.05) although the magnitude of this effect was smaller than for HR. With incremental atrial pacing, cardiac output increased and total pulmonary resistance (TPR) fell. However, effective arterial elastance, its mean resistive component (TPR/heart period; 0.60-0.27 vs. 0.79-0.45;p = 0.048), and its pulsatile component (0.27-0.18 vs 0.39-0.28;p = 0.03) all increased at faster HR. Conclusion Heart rate and BSA are associated with pulmonary RC time. As heart rate increases, the pulsatile and total load on the RV also increase. This relationship supports a hemodynamic mechanism for adverse effects of tachycardia on the RV.
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U2 - 10.1371/journal.pone.0166463
DO - 10.1371/journal.pone.0166463
M3 - Article
C2 - 27861600
AN - SCOPUS:84996587268
SN - 1932-6203
VL - 11
JO - PloS one
JF - PloS one
IS - 11
M1 - e0166463
ER -