原创力文档right atrial pressure affects the interaction between lung mechanics and right ventricular function in spontaneously breathing copd patients右心房压力影响肺力学之间的交互和自发呼吸copd患者的右心室功能.pdfVIP
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right atrial pressure affects the interaction between lung mechanics and right ventricular function in spontaneously breathing copd patients右心房压力影响肺力学之间的交互和自发呼吸copd患者的右心室功能
Right Atrial Pressure Affects the Interaction between
Lung Mechanics and Right Ventricular Function in
Spontaneously Breathing COPD Patients
1 1 1 1 1
Bart Boerrigter *, Pia Trip , Harm Jan Bogaard , Herman Groepenhoff , Frank Oosterveer , Nico
Westerhof1,2, Anton Vonk Noordegraaf 1
1 Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands, 2 Department of Physiology, Institute for Cardiovascular Research, VU
University Medical Center, Amsterdam, The Netherlands
Abstract
Introduction: It is generally known that positive pressure ventilation is associated with impaired venous return and
decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia.
Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been
firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these
cardiopulmonary interactions are influenced by right atrial pressure.
Methods: Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and
pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial
pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during
expiration were examined to evaluate changes in right ventricular output.
Results: Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The
decline in pulse pressure was most prominent in patients with a low right atrial f
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