Independence of Intrapericardial Right and Left Ventricular Performance in Septic Pulmonary Hypertension

J. C. Böck; B. C. Barker; Aileen D. Lim; H. Eichstädt; M. Pollycove; R. F. Lewis

doi:10.1055/s-0038-1629539

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1990; 29(06): 246-251
DOI: 10.1055/s-0038-1629539

ÜBersichtsartikel - Review Articles

Schattauer GmbH

Independence of Intrapericardial Right and Left Ventricular Performance in Septic Pulmonary Hypertension

J. C. Böck

¹From the Strahlenklinik und Poliklinik, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin, FR Germany, San Francisco, CA, USA

,

B. C. Barker

²From The Departments of Surgery, San Francisco, CA, USA

,

Aileen D. Lim

³From the Nuclear Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA

,

H. Eichstädt

¹From the Strahlenklinik und Poliklinik, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin, FR Germany, San Francisco, CA, USA

,

M. Pollycove

³From the Nuclear Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA

,

R. F. Lewis

²From The Departments of Surgery, San Francisco, CA, USA

› Author Affiliations

Abstract

To study the effect of septic pulmonary hypertension on right/left ventricular intrapericardial interactions thirteen trauma patients, seven septic and six non-septic controls, were compared. Ventricular volumes were derived from firstpass or gated equilibrium radionuclide angiocardiography, and related to body surface area. Systemic and pulmonary pressures were measured invasively. Pulmonary arterial pressure was significantly increased in the sepsis group. Although right ventricular end-diastolic volumes were higher in sepsis, left ventricular end-diastolic volumes were not decreased. In terms of intrapericardial right/left ventricular interactions these results indicate that the right and left ventricles operate independently in septic pulmonary hypertension.

Zusammenfassung

Ziel der Studie war die Untersuchung rechts/links-ventrikulärer Interaktionen bei septischer pulmonaler Hypertension. Sieben septische und sechs nichtseptische Patienten wurden verglichen. Ventrikelvolumina wurden radionuklidangiokardiographisch gemessen. Systemische und pulmonale Drücke wurden invasiv bestimmt. In der septischen Gruppe war der pulmonalarterielle Druck signifikant erhöht. Obwohl die rechtsventrikulären enddiastolischen Volumina in der septischen Gruppe erhöht waren, waren die linksventrikulären enddiastolischen Volumina in der septischen Gruppe normal. Bezüglich der untersuchten rechts/links-ventrikulären Interaktionen zeigen diese Ergebnisse, daß der rechte und linke Ventrikel bei septischen Patienten unabhängig voneinander arbeiten.

Full Text

References

References
1 Banister J, Torrance R W. The effect of the tracheal pressure upon flow: pressure relations in the vascular beds of isolated lungs. Q J Exp Physiol 1960; 45: 352-68.
2 Baum G L, Schwartz A, Llamas R, Castillo C. Left ventricular function in chronic obstructive disease. N Engl J Med 1971; 285: 361-5.
3 Bemis C E, Serur J R, Borkenhagen D, Sonnenblick E H, Urschel C W. Influence of right ventricular filling pressure on left ventricualr pressure dimension. Am J Physiol 1974; 226: 941-7.
4 Calvin J E, Drieger A A, Sibbald W J. An assessment of myocardial function in human sepsis utilizing ECG-gated cardiac scintigraphy. Chest 1981; 80: 579-86.
5 Carabello B A, Spann J F. The uses and limitations of end-systolic indices of left ventricular function. Circulation 1984; 69: 1058-64.
6 Cassidy S S, Ramanathan M. Dimensional analysis of the left ventricle during PEEP: relative septal and lateral wall displacement. Am J Physiol 1984; 246: H792-805.
7 Ellrodt A G, Riedinger M S, Kimchi A. et al. Left ventricular performance in septic shock: reversible segmental and global abnormalities. Am Heart J 1985; 110: 402-9.
8 Elzinga G, Grondelle R, Westerhof N, Bos G C. Ventricular interference. Am J Physiol 1974; 226: 941-7.
9 Ferlinz J. Right ventricular performance in essential hypertension. Circulation 1980; 61: 156-62.
10 Glantz S A, Misbach G A, Moores W Y. et al. The pericardium substantially affects the left ventricular pressure-volume relationship in the dog. Circ Res 1978; 42: 433-41.
11 Greene R, Lind S, Jantsch H. et al. Pulmonary vascular obstruction in severe ARDS: angiographic alterations after i. v. fibrinolytic therapy. Am J Roentgenol 1987; 148: 501-8.
12 Grossman W, Braunwald E, Mann T, McLaurin L P, Green L H. Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation 1977; 56: 845-52.
13 Hoffman M J, Greenfield L J, Surgerman H J, Tatum J L. Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg 1983; 198: 307-19.
14 Hurford W E, Barlai-Kovach M, Strauss H W, Zapol W M, Lowenstcin E. Canine biventricular performance during acute progressive pulmonary microembolisation: regional myocardial perfusion and fatty acid uptake. J Crit Care 1987; 02: 270-81.
15 Jacobs E, Bone R. Mediators of septic lung injury. Med Clin North Amer 1983; 67: 701-15.
16 Jardin F, Farcot J C, Boisante L. et al. Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 1981; 304: 387-92.
17 Kimchi A, Ellrodt A G, Berman D S. et al Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study. J Am Coll Cardiol 1984; 04: 945-51.
18 Koolen J J, Visser C A, Wever E. et al. Transoesophageal two-dimensional echo- cardiographic evaluation of biventricular dimension and function during end-expiratory pressure ventilation after coronary artery bypass. Am J Cardiol 1987; 59: 1047-51.
19 Laver M B, Strauss H W, Pohost G M. Right and left ventricular geometry: adjustments during acute respiratory failure. Crit Care Med 1979; 07: 509-19.
20 Mangano D T. The effect of pericardium on ventricular systolic function in man. Circulation 1980; 61: 352-7.
21 Ognibebe F P, Parker M M, Natanson C, Shellhamer J H, Parillo J E. Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 1988; 93: 903-10.
22 Parker M, Shelhamer J H, Bacharach S L. et al. Profound but reversible myocardial depression in patients with septic shock. Ann Int Med 1984; 100: 483-90.
23 Parker M M, Fuffredini A F, Natanson C. et al. Responses of left ventricular function in survivors and non-survivors of septic shock. J Crit Care 1989; 04: 19-25.
24 Parker M M, McCarthy K E, Ognibene F P, Parillo J E. Right ventricular dysfunction and dilatation, similar to left ventricular changes, characterize the cardiac depression in shock. Chest 1990; 97: 126-31.
25 Pasque M K, v Trigt P, Pellom G L, Freedman B M, Wechsler A S. Assessment of the intrinsic contractile status of the heart during sepsis by myocardial pressure-dimen- sion analysis. Ann Surg 1988; 208: 110-6.
26 Rackow E C, Kaufman B S, Falk J L, Astiz M E, Weil M H. Hemodynamic response to fluid repletion in patients with septic shock: evidence for early depression of cardiac performance. Circ Shock 1987; 22: 11-22.
27 Raper R, Sibbald W. Misled by the wedge? The Swan-Ganz catheter and left ventricular preload. Chest 1988; 89: 427-34.
28 Sibbald W J, Driedger A A. Right ventricular function in acute disease states: pathophysiologic considerations. Crit Care Med 1983; 11: 339-45.
29 Sibbald W J, Driedger A A, Myers M L, Shork A IK, Wells G A. Biventricular function in the adult respiratory distress syndrome. Hemodynamic and radionuclideassessment, with special emphasis on right ventricular function. Chest 1983; 84: 126-34.
30 Stool E W, Mullins C B, Leshin S J, Mitchell J H. Dimensional changes of the left ventricle during acute pulmonary arterial hypertension in dogs. Am J Cardiol 1974; 33: 868-75.
31 Suffrcdini A F, Fromm R E, Parker M M ctal. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med 1989; 321: 280-7.
32 Sugawa K. The ventricular pressure-volumc diagram revisited. Circ Res 1978; 43: 677-87.
33 Suter P M. Right ventricular pathophysiology in the critically ill. Clin Anesth 1985; 03: 899-907.
34 Tucker A, Weir E K, Grover R F, Reeves J T. Oxygen tension dependent pulmonary vascular response to vasoactive agents. Can Physiol Pharmacol 1977; 55: 251-7.
35 Zapol W M, Snider M T. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 1977; 296: 476-80.