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Published online before print January 23, 2008, 10.1183/09031936.00135407
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Eur Respir J 2008; 31:1160-1166
Copyright ©ERS Journals Ltd 2008

Right ventricular contractility in systemic sclerosis-associated and idiopathic pulmonary arterial hypertension

M. J. Overbeek1, J-W. Lankhaar1,2, N. Westerhof1,3, A. E. Voskuyl4, A. Boonstra1, J. G. F. Bronzwaer5, K. M. J. Marques5, E. F. Smit1, B. A. C. Dijkmans4 and A. Vonk-Noordegraaf1

1 Depts of Pulmonary Diseases, 2 Physics and Medical Technology, 3 Physiology, 4 Rheumatology, and 5 Cardiology, Institute for Cardiovascular Research. VU University Medical Centre, Vrije University, Amsterdam, The Netherlands.

CORRESPONDENCE: A. Vonk-Noordegraaf, Dept of Pulmonary Diseases, VU University Medical Centre, De Boelelaan 1117, 1081 HVP.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Fax: 31 204444328. E-mail: A.Vonk{at}VUmc.nl

Keywords: Myocardial contraction, pump function graph, right ventricular function, right ventricular pressure, stroke volume

Received: October 14, 2007
Accepted January 2, 2008

Since systemic sclerosis (SSc) also involves the heart, the aim of the present study was to evaluate possible differences in right ventricular (RV) pump function between SSc-associated pulmonary arterial hypertension (PAH; SScPAH) and idiopathic PAH (IPAH).

In 13 limited cutaneous SScPAH and 17 IPAH patients, RV pump function was described using the pump function graph, which relates mean RV pressure (PRV) and stroke volume index (SVI). Differences in pump function result in shift or rotation of the pump function graph. PRV and SVI were measured using standard catheterisation. The hypothetical isovolumic PRV (PRV,iso) was estimated using a single-beat method. The pump function graph was approximated by a parabola: PRV = PRV,iso[1–(SVI/SVImax)2], where SVImax is the hypothetical maximal SVI at zero PRV, enabling calculation of SVImax.

There were no differences in SVI and SVImax. Both PRV and PRV,iso were significantly lower in SScPAH than in IPAH (PRV 30.7±8.5 versus 41.2±9.4 mmHg; PRV,iso 43.1±12.4 versus 53.5±10.0 mmHg). Since higher pressures were found at similar SVI, the difference in the pump function graph results from lower contractility in SScPAH than in IPAH.

Right ventricular contractility is lower in systemic sclerosis-associated pulmonary arterial hypertension than in idiopathic pulmonary arterial hypertension.




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