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Right ventricular free wall pacing improves cardiac pump function in severe pulmonary arterial hypertension: a computer simulation analysis.
. 2009 Dec; 297(6):H2196-205.

Abstract

In pulmonary arterial hypertension (PAH), duration of myofiber shortening is prolonged in the right ventricular (RV) free wall (RVfw) compared with that in the interventricular septum and left ventricular free wall. This interventricular mechanical asynchrony eventually leads to right heart failure. We investigated by computer simulation whether, in PAH, early RVfw pacing may improve interventricular mechanical synchrony and, hence, cardiac pump function. A mathematical model of the human heart and circulation was used to simulate left ventricular and RV pump mechanics and myofiber mechanics. First, we simulated cardiovascular mechanics of a healthy adult at rest. Size and mass of heart and blood vessels were adapted so that mechanical tissue load was normalized. Second, compensated PAH was simulated by increasing mean pulmonary artery pressure to 32 mmHg while applying load adaptation. Third, decompensated PAH was simulated by increasing mean pulmonary artery pressure further to 79 mmHg without further adaptation. Finally, early RVfw pacing was simulated in severely decompensated PAH. Time courses of circumferential strain in the ventricular walls as simulated were similar to the ones measured in healthy subjects (uniform strain patterns) and in PAH patients (prolonged RVfw shortening). When simulating pacing in decompensated PAH, RV pump function was best upon 40-ms RVfw preexcitation, as evidenced by maximal decrease of RV end-diastolic volume, reduced RVfw myofiber work, and most homogeneous distribution of workload over the ventricular walls. Thus our simulations indicate that, in decompensated PAH, RVfw pacing may improve RV pump function and may homogenize workload over the ventricular walls.

Authors+Show Affiliations

Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, and Department of Cardiology, University Hospital Maastricht, Universiteitssingel 50, PO Box 616, 6200MR Maastricht, The Netherlands. j.lumens@fys.unimaas.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19837949

Citation

Lumens, Joost, et al. "Right Ventricular Free Wall Pacing Improves Cardiac Pump Function in Severe Pulmonary Arterial Hypertension: a Computer Simulation Analysis." American Journal of Physiology. Heart and Circulatory Physiology, vol. 297, no. 6, 2009, pp. H2196-205.
Lumens J, Arts T, Broers B, et al. Right ventricular free wall pacing improves cardiac pump function in severe pulmonary arterial hypertension: a computer simulation analysis. Am J Physiol Heart Circ Physiol. 2009;297(6):H2196-205.
Lumens, J., Arts, T., Broers, B., Boomars, K. A., van Paassen, P., Prinzen, F. W., & Delhaas, T. (2009). Right ventricular free wall pacing improves cardiac pump function in severe pulmonary arterial hypertension: a computer simulation analysis. American Journal of Physiology. Heart and Circulatory Physiology, 297(6), H2196-205. https://doi.org/10.1152/ajpheart.00870.2009
Lumens J, et al. Right Ventricular Free Wall Pacing Improves Cardiac Pump Function in Severe Pulmonary Arterial Hypertension: a Computer Simulation Analysis. Am J Physiol Heart Circ Physiol. 2009;297(6):H2196-205. PubMed PMID: 19837949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right ventricular free wall pacing improves cardiac pump function in severe pulmonary arterial hypertension: a computer simulation analysis. AU - Lumens,Joost, AU - Arts,Theo, AU - Broers,Bernard, AU - Boomars,Karin A, AU - van Paassen,Pieter, AU - Prinzen,Frits W, AU - Delhaas,Tammo, Y1 - 2009/10/16/ PY - 2009/10/20/entrez PY - 2009/10/20/pubmed PY - 2010/2/18/medline SP - H2196 EP - 205 JF - American journal of physiology. Heart and circulatory physiology JO - Am. J. Physiol. Heart Circ. Physiol. VL - 297 IS - 6 N2 - In pulmonary arterial hypertension (PAH), duration of myofiber shortening is prolonged in the right ventricular (RV) free wall (RVfw) compared with that in the interventricular septum and left ventricular free wall. This interventricular mechanical asynchrony eventually leads to right heart failure. We investigated by computer simulation whether, in PAH, early RVfw pacing may improve interventricular mechanical synchrony and, hence, cardiac pump function. A mathematical model of the human heart and circulation was used to simulate left ventricular and RV pump mechanics and myofiber mechanics. First, we simulated cardiovascular mechanics of a healthy adult at rest. Size and mass of heart and blood vessels were adapted so that mechanical tissue load was normalized. Second, compensated PAH was simulated by increasing mean pulmonary artery pressure to 32 mmHg while applying load adaptation. Third, decompensated PAH was simulated by increasing mean pulmonary artery pressure further to 79 mmHg without further adaptation. Finally, early RVfw pacing was simulated in severely decompensated PAH. Time courses of circumferential strain in the ventricular walls as simulated were similar to the ones measured in healthy subjects (uniform strain patterns) and in PAH patients (prolonged RVfw shortening). When simulating pacing in decompensated PAH, RV pump function was best upon 40-ms RVfw preexcitation, as evidenced by maximal decrease of RV end-diastolic volume, reduced RVfw myofiber work, and most homogeneous distribution of workload over the ventricular walls. Thus our simulations indicate that, in decompensated PAH, RVfw pacing may improve RV pump function and may homogenize workload over the ventricular walls. SN - 1522-1539 UR - https://www.unboundmedicine.com/medline/citation/19837949/Right_ventricular_free_wall_pacing_improves_cardiac_pump_function_in_severe_pulmonary_arterial_hypertension:_a_computer_simulation_analysis_ L2 - https://journals.physiology.org/doi/10.1152/ajpheart.00870.2009?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -