• J. Thorac. Cardiovasc. Surg. · Dec 2017

    Comparative Study

    The importance of capillary density-stroke work mismatch for right ventricular adaptation to chronic pressure overload.

    • Pierre-Emmanuel Noly, François Haddad, Jennifer Arthur-Ataam, Nathaniel Langer, Peter Dorfmüller, Fanny Loisel, Julien Guihaire, Benoit Decante, Lilia Lamrani, Elie Fadel, and Olaf Mercier.
    • School of Medicine, Paris-Sud University and Paris-Saclay University, Kremlin-Bicêtre, France; Research and Innovation Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, DHU Thorax Innovation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
    • J. Thorac. Cardiovasc. Surg. 2017 Dec 1; 154 (6): 2070-2079.

    ObjectiveMechanisms of right ventricular (RV) adaptation to chronic pressure overload are not well understood. We hypothesized that a lower capillary density (CD) to stroke work ratio would be associated with more fibrosis and RV maladaptive remodeling.MethodsWe induced RV chronic pressure overload over a 20-week period in 2 piglet models of pulmonary hypertension; that is, a shunt model (n = 5) and a chronic thromboembolic pulmonary hypertension model (n = 5). We assessed hemodynamic parameters and RV remodeling as well as RV CD, fibrosis, and angiogenic factors expression.ResultsAlthough RV was similarly hypertrophied in both models, maladapted RV remodeling with impaired systolic function was only seen in chronic thromboembolic pulmonary hypertension group members who had lower CD (484 ± 99 vs 1213 ± 74 cap/mm2; P < .01), lower CD to stroke work ratio (0.29 ± 0.07 vs 0.82 ± 0.16; P = .02), higher myocardial fibrosis (15.4% ± 3.8% vs 8.0% ± 2.5%; P < .01), as well as a higher angiogenic and fibrosis factors expression.ConclusionsThe RV adaptive response to chronic pressure overload differs between 2 different piglet models of PH. Mismatch between angiogenesis and workload (CD to stroke work ratio) was associated with greater degree of myocardial fibrosis and RV dysfunction and could be a promising index of RV maladaptation. Further studies are needed to understand the underlying mechanisms.Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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