Right ventricular reserve in a piglet model of chronic pulmonary hypertension.

Abstract

Right ventricular (RV) response to exercise or pharmacological stress is not well documented in pulmonary hypertension (PH). We investigated the relationship between RV reserve and ventricular-arterial coupling. Surgical ligation of the left pulmonary artery was performed in 13 Large White piglets (PH group), thereafter weekly embolisations of the right lower lobe were performed for 5 weeks. A control group of six piglets underwent sham procedures. Right heart catheterisation and echocardiography were performed at week 6. Pressure-volume loops were recorded before and after dobutamine infusion. Induction of experimental PH resulted in a higher mean &#xb1; sd pulmonary artery pressure (34 &#xb1; 9 versus 14 &#xb1; 2 mmHg; p<0.01) and in a lower ventricular-arterial coupling efficiency (0.66 &#xb1; 0.18 versus 1.24 &#xb1; 0.17; p<0.01) compared with controls at 6 weeks. Dobutamine-induced relative changes in RV stroke volume index (SVI) and end-systolic elastance were lower in the PH group (mean &#xb1; SD 47 &#xb1; 5% versus 20 &#xb1; 5%, p<0.01, and 81 &#xb1; 37% versus 32 &#xb1; 14%, p<0.01, respectively). Change in SVI was strongly associated with resting ventricular-arterial coupling (R(2)=0.74; p<0.01). RV reserve was associated with ventricular-arterial coupling in a porcine model of chronic pressure overload.