Source: Annual Congress 2011 - Physiology of human pulmonary hypertension
Disease area: Pulmonary vascular diseases

Abstract

The aim: to assess the influence of volume load on right heart hemodynamics in pts with moderate and severe CTEPH.
Patients and methods: 20 patients (mean age - 47± 11, 15 males and 5 females). The 1 group consisted of 9 pts with PAP≤30 mm Hg, the 2 group – 11 pts with PAP>30 mm Hg. Right ventricular end-diastolic volume and ejection fraction were evaluated by thermodilution method [Lichtwarck-Aschoff, 2002].
Results: are summarized in the following table:

	Stages	PAP<=30	PAP>30
RVEDVI, ml/m2	1	115+-15.1	172+-18,7
	2	145+-16.1	183+-26,7
RVEF, %	1	37.9+-3.75	20.8+-3.15a
	2	37.4+-2.75	22.2+-3.73a
CI, l*min/m2	1	3.00+-0.16	2.38+-0.25
	2	3.49+-0.24	2.40+-0.26a
PVRI, dyn*s*sm-5\m2	1	113+-18.0	771+-203
	2	158+-27.5	709+-222
RVEDVI1/2*RVEFI1/2*PAP1/2	1/2	0.80*1.00*0.8	1.01*0.97*0.95
RVSWI1/2	1/2	0.67+-0.05	0.95+-0.05a

Stages: 1-before volume load, 2 – after rapid infusion of 400 ml of the saline. PVRI – pulmonary vascular resistance index. a- statistically significance (p<0.05) between groups.
After volume load: The difference in RVEDVI between the groups was not significant. The difference in CI between the groups became significant. This confirmed that there was no increase in CI in group 2. The increase of CI in group 1 was accompanied by PVRI rise. PVRI in group 2 remained high. Right ventricle stroke work dynamic (RVSWI1/2) indicated the presence of diastolic reserves of the RV in moderate CTEPH.
Conclusion. There are two main haemodynamic consequences in CTEPH: RV systolic dysfunction due to afterload increase and diastolic impairment as a response to volume load leading to RVEF decrease. The severity of right heart changes could be used in preoperative risk stratification in CTEPH patiens.

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N. Khorokhordin, P. Yablonsky, A. Boyarkin, V. Golovin, T. Fedorova, E. Pavlushkov, I. Karmamov, O. Karmanov (Saint-Petersburg, Russian Federation). Right heart volume load response in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Respir J 2011; 38: Suppl. 55, 2314

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