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    This document discusses the echocardiographic pattern of acute cor pulmonale (ACP). 1. The right ventricle's diastolic function is tolerant to acute overload and will dilate, while its systolic function is sensitive. A paradoxical septal motion can indicate systolic overload. 2. An acute dilation of the right ventricle restricts left ventricular filling due to the pericardium, impairing left ventricular relaxation. 3. Studies found an incidence of ACP of 25% in ARDS patients and 61% of massive PE patients, as indicated by echocardiography. ACP is defined by signs of both diastolic and systolic overload on

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    This document discusses the echocardiographic pattern of acute cor pulmonale (ACP). 1. The right ventricle's diastolic function is tolerant to acute overload and will dilate, while its systolic function is sensitive. A paradoxical septal motion can indicate systolic overload. 2. An acute dilation of the right ventricle restricts left ventricular filling due to the pericardium, impairing left ventricular relaxation. 3. Studies found an incidence of ACP of 25% in ARDS patients and 61% of massive PE patients, as indicated by echocardiography. ACP is defined by signs of both diastolic and systolic overload on

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    © All Rights Reserved
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    33 views25 pages

    Acute Cor Pulmonale

    Uploaded by

    kuncupcupu1368
    This document discusses the echocardiographic pattern of acute cor pulmonale (ACP). 1. The right ventricle's diastolic function is tolerant to acute overload and will dilate, while its systolic function is sensitive. A paradoxical septal motion can indicate systolic overload. 2. An acute dilation of the right ventricle restricts left ventricular filling due to the pericardium, impairing left ventricular relaxation. 3. Studies found an incidence of ACP of 25% in ARDS patients and 61% of massive PE patients, as indicated by echocardiography. ACP is defined by signs of both diastolic and systolic overload on

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    of 25

    ECHO PATTERN OF ACUTE COR

    PULMONALE

    Antoine Vieillard-Baron, Boulogne, France

    1- Unlike the left ventricle, the RV is able to dilate acutely under


    abnormal conditions.

    Its diastolic function is tolerant


    A failed RV is dilated
    2- Unlike the left ventricle, the RV not easily adapts to an acute
    increase in its afterload.

    Its systolic function is sensitive


    A paradoxical septal motion can be visualized in
    certain conditions

    ACP = Echocardiographic definition


    Diastolic overload (dilatation)
    + systolic overload (paradoxical septal motion)

    I
    RV DIASTOLIC FUNCTION IS
    TOLERANT

    No dilatation: RVEDA/LVEDA < 0.6


    Moderate dilatation: RVEDA/LVEDA 0.6 - 1
    Major dilatation: RVEDA/LVEDA > 1
    Jardin Chest 1997

    Healthy volunteers (n=44)


    1

    0.6

    RVEDA/LVEDA
    =
    0.48+0.11

    STDVD/STDVG (ETO)

    1.3

    12 patients
    1.04

    0.78

    0.52

    r = 0.95
    p<.00001

    0.26

    0.26

    0.52

    0.78

    STDVD/STDVG (A4C)

    1.04

    1.3

    Normal RV function

    Massive PE
    D1

    Normal RV function

    ARDS related to varicellous


    pneumonia

    Vieillard-Baron ICM 2006

    THE LV CONSEQUENCES OF
    AN ACUTE RV DILATATION

    Because of the pericardium, the sum of


    cardiac cavities keep constant in acute
    conditions.
    Any RV dilatation leads to a LV restriction
    which impairs its filling. This induces a
    pattern of relaxation impairment of the LV.

    Taylor AJP 1967

    EDA RV+LV
    (cm2)

    LVEDV
    (cm3)

    45

    100

    40

    90

    35

    80

    30

    70

    25

    60

    20

    50

    15

    40

    10

    30

    20

    ACP = 0

    ACP = 1

    ACP = 0

    ACP = 1

    Vieillard-Baron CCM 2001

    TEE study at D3
    75 SDRA (1996-2001)
    Gr I (56 patients)
    no ACP (75 %)

    Gr II (19 patients)
    ACP (25 %)

    LVEDV 60 16
    E/A mit 1.3 0.4

    50 15* (cm3/m2)
    0.8 0.2*

    SI
    HR

    25 9* (cm3/m2)
    112 16* (bt/mn)

    32 9
    96 19

    Vieillard-Baron CCM 2001

    P/F 80
    Crs 25 mL/cmH2O

    P/F 40
    Crs 20 mL/cmH2O
    NE 0.6 g/kg/min

    P/F 35
    Crs 11 mL/cmH2O
    NE 1.5 g/kg/min

    II
    RV SYSTOLIC FUNCTION IS
    SENSITIVE

    Redington Br Heart J 1990

    2
    1: Opening of the pulmonic valve

    2: Beginning of relaxation
    3: Closing of pulmonic valve

    Elzinga 1990

    Jardin N Engl J Med 1981

    Normal RV function

    Massive PE
    D1

    Normal RV function

    ARDS related to varicellous


    pneumonia

    Vieillard-Baron AJRCCM 2002

    Ryan JACC 1985

    Vieillard-Baron AJRCCM 2002

    INCIDENCE OF ACP IN ICU

    CCM 2001
    ICM 2001

    75 ARDS submitted to a
    protective ventilation
    TEE at D3
    Incidence of ACP: 25%

    161 massive PE
    TTE at D1
    Incidence of ACP: 61%

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