Right heart remodeling in coronary heat disease: clinico-pathophysiological correlations
Abstract
Aim. To study right ventricular (RV) geometry and analyze clinico-pathophysiological processes, associated with right heart remodeling in coronary heart disease (CHD) patients.
Material and methods. The study included 184 CHD patients, who underwent dobutamine stress echocardiography (EchoCG).
Results. In CHD patients, structural and functional abnormalities of right heart chambers were registered: RV dilatation, dysconfiguration (increased ratio of RV transversal to longitudinal size), right atrium (RA) dilatation, tricuspidal valve fibrotic annulus distention, associated with tricuspidal insufficiency, and RF systolic function decrease. Among pathogenetic factors of right heart remodeling, there were: left heart function, mitral insufficiency, RV ischemic myocardial dysfunction, interventricular septum function.
Conclusion.RV function determinants and right heart remodeling mechanisms are complex and multifactorial. This study analyzed regional RV geometry in various categories of CHD patients, and pathogenesis of right heart remodeling.
About the Authors
N. S. Buslenko
A.N. Bakoulev Research Center for Cardiovascular Surgery, Russian Academy of Medical Science, Moscow
Russian Federation
Russian Federation
Yu. I. Buziashvili
A.N. Bakoulev Research Center for Cardiovascular Surgery, Russian Academy of Medical Science, Moscow
Russian Federation
Russian Federation
I. V. Koksheneva
A.N. Bakoulev Research Center for Cardiovascular Surgery, Russian Academy of Medical Science, Moscow
Russian Federation
Russian Federation
E. U. Asymbekova
A.N. Bakoulev Research Center for Cardiovascular Surgery, Russian Academy of Medical Science, Moscow
Russian Federation
Russian Federation
O. M. Sherstyannikova
A.N. Bakoulev Research Center for Cardiovascular Surgery, Russian Academy of Medical Science, Moscow
Russian Federation
Russian Federation
References
1. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling- concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. JACC 2000; 35: 569-82.
2. Гланц С. Медико-биологическая статистика. Москва 1999.
3. Hirose K, Reed JE, Rumberger JA. Serial changes in left and right ventricular systolic and diastolic dynamics during the first year after an index left ventricular Q-wave myocardial infarction. JACC 1995; 25: 1097-104.
4. Hirose K, Reed JE, Rumberger JA. Serial changes in regional right ventricular free wall and left ventricular septal wall lengths during the first 4 to 5 years after index anterior wall myocardial infarction. JACC 1995; 26: 394- 400.
5. Hirose K, Shu NH, Reed JE, et al. Right ventricular dilatation and remodeling the first year after an initial transmural wall left ventricular myocardial infarction. Am J Cardiol 1993; 72: 1126-30.
6. Marmor A, Geltman EN, Biello DR, et al. Functional response of the right ventricle to myocardial infarction: dependence on the site of left ventricular infarction. Circulation 1981; 64: 1005-11.
7. Shah PD, Maddahi J, Berman DS, et al. Scintigraphically detected predominant right ventricular dysfunction in acute myocardial infarction: clinical and hemodynamic correlates and implications for therapy and prognosis. Am J Cardiol 1985; 6: 1264-72.
8. Cabin HS, Clubb KS, Wackers FJT. Right ventricular myocardial infarction with anterior wall left ventricular infarction. An autopsy study. Am Heart J 1987; 113: 16-23.
9. Hirsowitz GS, Lakier JB, Goldstein S. Right ventricular function evaluated by radionuclide angiography in acute myocardial infarction. Am Heart J 1984; 108: 949- 54.
10. Berger HJ, Johnstone DE, Sands JM, et al. Response of right ventricular ejection fraction during exercise in patients with coronary artery disease. Circulation 1979; 60: 1292-300.
11. Галанкин В.Н. Архитектоника миокарда желудочков сердца и ее изменения при гипертрофии. Кардиология 1973; 7: 5-12.
12. Dell’Italia L. The right ventricle: anatomy, physiology, and clinical importance. Curr Prob Cardiol 1991; 16: 658-720.
13. Gewirtz H, Gold HK, Fallon JT, et al. Role of right ventricular infarction in cardiogenic shock associated with inferior myocardial infarction. Br Heart J 1979; 42: 719-25.
14. DellItalia LJ, Starling MR, O’Rourke RA. Physical examination for exclusion of hemodynamically important right ventricular infarction. Ann Intern Med 1983; 99: 608- 11.
15. Nemerovaski M, Shah PK, Pichler M, et al. Radionuclide assessment of sequential changes in left and right ventricular function following first acute transmural myocardial infarction. Am Heart J 1982; 104: 709-17.
16. Lisa JR, Ring A. Myocardial infarction or gross fibrosis: analysis of one hundred necropsies. Arch Intern Med 1932; 50: 131-41.
17. Applebaum E, Nicolson GHB. Occlusive diseases of the coronary arteries: an analysis of the pathological anatomy in one hundred sixty- eight cases, with electrocardiographic correlation in thirtysix of these. Am Heart J 1934; 10: 662- 79.
18. Erhardt LR. Clinical and pathological observations in different types of acute myocardial infarction: a study of 84 patients deceased after treatment in a coronary care unit. Acta Med Scand 1974; 26(Suppl.): 7-78.
19. Денисенко Б.А. Сочетанный инфаркт миокарда правого и левого желудочков. Автореф дисс докт мед наук. Новокузнецк 1986.
20. Andersen HR, Falk E, Nielsen D. Right ventricular infarction: size and topography in coronary heart disease: a prospective study comprising 107 consecutive autopsies from a coronary care unit. JACC 1987; 10: 1223-32.
21. Maddahi J, Berman DS, Matsuoka DT, et al. Right ventricular ejection fraction during exercise in normal subjects in coronary artery disease patients: assessment by multiple- gated equilibrium scintigraphy. Circulation 1980; 62: 133-40.
22. Slutsky R, Hooper W, Gerber K, et al. Assessment of right ventricular function at rest and during exercise in patients with coronary heart disease: A new approach using equilibrium radionuclide angiography. Am J Cardiol 1980; 45: 63.
23. Parodi O, Neglia D, Marcassa C, et al. Right coronary artery disease. Pathophysiology, clinical relevance, and methods for recognition. Circulation 1991; 83(Suppl. 5): III54- 61.
24. Coma-Canella MD. Stress- induced ST segment shift in leads V3R and V4R after acute myocardial infarction. Am Heart J 1992; 123: 362-8.
25. San-Roman JA, Vilacosta I, Rollan MJ, et al. Right ventricular asynergy during dobutamine- atropine echocardiography. JACC 1997; 30: 2: 430-5.
26. Pavlovic M, Tomasevic M, HadziPesic L, et al. Regional right ventricular wall motion disoders during dypiridamol stress echocardiography. (abstr.). III-th Congress of the European Society of Cardiology. August 24- 28, 1997, Stockholm, Sweden, Abstract N 4019.
27. Fixler D.E., Monroe G.A., Wheeler J.M. Hemodynamic alterations during septal or right ventricular ischemia in dogs. Am Heart J 1977; 73: 210-15.
28. Argawal JB, Yamazaki H, Bodenheimer MM, et al. Effects of isolated interventricular septal ischemia on global and segmental function of the canine right and left ventricle. Am Heart J 1981; 102: 654-8.
29. Molaug M, Geiran O, Kil F. Compensatory mechanisms evoked by septal ischemia in dogs. Am J Cardiol 1983; 51: 201-6.
30. Li KS, Santamore WP. Contribution of each wall to biventricular function. Cardiovasc Res 1993; 27: 792-800.
31. Klima U, Guerrero JL, Vlahakes GJ. Contribution of the interventricular septum to maximal right ventricular function. Eur J Cardio-Thorac Surg 1998; 14: 250-5.
32. Nakamura S, Iwasaka T, Kimura Y, et al. Right ventricular ejection fraction during exercise in patients with recent myocardyal infarction: effect of the interventricular septum. Am Heart J 1994; 127: 49-55.
33. Бусленко Н.С., Бузиашвили Ю.И., Кокшенева И.В., Асымбекова Э.У. Роль межжелудочковой перегородки как важной определяющей функции правого желудочка. Кардиоваск тер профил 2002; 4: 54-62.
34. Starr I, Jetfers WT, Merse RH. The absence of conspicuous increments of venous pressure after severe damage to the right ventricle of the dog, with discussion of the relation between clinical and congestive heart failure and heart disease. Am Heart J 1943; 20: 291-301.
35. Donald DE, Essex HE. Studies on chronic effects of ligation of the canine right coronary artery. Am J Physiol 1954; 176: 431-8.
Review
For citations:
Buslenko N.S., Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Sherstyannikova O.M. Right heart remodeling in coronary heat disease: clinico-pathophysiological correlations. Cardiovascular Therapy and Prevention. 2005;4(5):23-31. (In Russ.)
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