Quantification of right ventricular afterload in patients with and without pulmonary hypertension.

@article{Lankhaar2006QuantificationOR,
  title={Quantification of right ventricular afterload in patients with and without pulmonary hypertension.},
  author={J. W. Lankhaar and Nico Westerhof and Theo J. C. Faes and Koen M.J. Marques and J. Tim Marcus and Pieter E Postmus and Anton Vonk-Noordegraaf},
  journal={American journal of physiology. Heart and circulatory physiology},
  year={2006},
  volume={291 4},
  pages={
          H1731-7
        }
}
Right ventricular (RV) afterload is commonly defined as pulmonary vascular resistance, but this does not reflect the afterload to pulsatile flow. The purpose of this study was to quantify RV afterload more completely in patients with and without pulmonary hypertension (PH) using a three-element windkessel model. The model consists of peripheral resistance (R), pulmonary arterial compliance (C), and characteristic impedance (Z). Using pulmonary artery pressure from right-heart catheterization… 

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References

SHOWING 1-10 OF 44 REFERENCES

Compliance of the Human Pulmonary Arterial System in Disease

N2O-plethysmography can provide a reliable and repeatable, noninvasive method for investigation of the pulmonary vascular bed and the relationships between compliance and pressure and pulsatility index and RC time constant are developed.

MRI evaluation of right ventricular pressure overload in chronic obstructive pulmonary disease

This MRI protocol provides a tool to assess the effects of RV pressure overload in COPD before heart failure has become manifest and is indicative of pulmonary hypertension.

Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique.

A pulsed Doppler technique permitted the noninvasive estimation of the pulmonary artery pressure and the time to peak flow (acceleration time, AcT) and right ventricular ejection time (RVET) were measured from the flow velocity pattern.

Pulmonary arterial compliance in dogs and pigs: the three-element windkessel model revisited.

CPPM is a consistent estimate of pulmonary arterial compliance in pigs and dogs, CWK-3 and SV/PP overestimate compliance, and CWK -3 is unreliable when wave reflections are small.

Does normal pulmonary impedance constitute the optimum load for the right ventricle?

  • H. PieneT. Sund
  • Engineering, Biology
    The American journal of physiology
  • 1982
The right ventricular and the pulmonary arterial tree appear to constitute a matched pump-load system over a broad range of load conditions.

Pulmonary Arterial Pulse Wave Velocity and Impedance in Man

The elasticity of the pulmonary arterial tree appears to be as important as the state of the arterioles and capillaries in determining the energy required for pulsatile pulmonary blood flow.

The compliance of the porcine pulmonary artery depends on pressure and heart rate

Because the pulmonary artery constricts with increasing heart rate, Cps will be overestimated during procedures where heart rate increases, and Cd should be determined on a beat‐to‐beat basis to calculate flow because it changes with mean pulmonary arterial pressure and heart rate.

Measurement of total pulmonary arterial compliance using invasive pressure monitoring and MR flow quantification during MR-guided cardiac catheterization.

The feasibility of quantifying total arterial compliance utilizing magnetic resonance (MR) flow data and invasive pressure measurements is demonstrated and it is demonstrated that there is an inverse relation between compliance and resistance.

Pulmonary artery reflection for differentially diagnosing primary pulmonary hypertension and chronic pulmonary thromboembolism.