Performance of the failing and nonfailing right ventricle of patients with pulmonary hypertension

Abstract

Hemodynamic performance of the right ventricle was measured in 34 patients: 17 with pulmonary hypertension, 9 with pulmonary hypertension and right ventricular failure and 8 control subjects. Among the patients with pulmonary hypertension who did not have right ventricular failure, right ventricular maximal isovolumic rate of development of ventricular pressure ($\text{dP}\text{dt}$) was significantly elevated (P < 0.001), whereas maximal $\text{1}\text{P}$$\text{dP}\text{dt}$ and maximal velocity of contractile element shortening (V_max) were comparable with values observed in control subjects. The patients with pulmonary hypertension who had right ventricular failure also showed an augmented right ventricular maximal $\text{dP}\text{dt}$ (P < 0.001) and normal $\text{1}\text{P}$$\text{dP}\text{dt}$ and V_max. These observations indicate that in pulmonary hypertensive heart disease, even when the right ventricle failed in a clinical sense, the contractile effort was normal. Consequently, right ventricular failure may develop in patients with pulmonary hypertensive heart disease even though the cardiac muscle performs normally as a contractile tissue.