[Right ventricle insufficiency in pulmonary arterial hypertension. Physiopathologic considerations]. / Insuficiencia ventricular derecha en la hipertensión arterial pulmonar. Consideraciones fisiopatológicas.

The present review is focused on chronic RV pressure overload or Cor Pulmonale as it may occur in the setting of two distinct disorders: those associated with abnormal pulmonary gas exchange (hypoxemia and/or hypercapnia) where chronic obstructive pulmonary disease (COPD) is the leading cause, and those associated with pulmonary vascular obstruction where primary pulmonary hypertension (PDDH) is the representative example. The clinical curse, prognostic, implications, and therapeutic strategies differ considerably in these two clinical entities. Right ventricular failure (RVF) may adversely influence the natural history and prognosis of patients with diverse cardiopulmonary disorders. It has been long established that right ventricular (RV) ischemia, RV overload, and RV pressure overload, alone or in combination, are the main factors involved in the pathogenesis of RVF. From the pathophysiologic point of view, RVF of COPD is more a congestive type of failure, in which activation of renin-angiotensin system is involved. In PPH, a low cardiac output state is predominant and the precise mechanism of RVF remains unknown. Current evidence in favor of the pathogenetic role of ischemia, adrenergic overdrive, and genetic determination are all reviewed during the course.

[Echocardiographic grading of cor pulmonale in chronic lung diseases]. / Echokardiographische Schweregradbeurteilung des Cor pulmonale bei chronischen Lungenerkrankungen.

The extent of right heart strain determines the prognosis of chronic lung disease. The value of a simple semiquantitative echocardiographic grading system for cor pulmonale was assessed in 69 patients (24 females, 45 males, age 61 +/- 12 years, ranging from 28-82 years) suffering from chronic lung disease. The patients were classified by echocardiography into four groups, Grade 0 consisting of those without evidence of right heart strain and three groups showing increasing severity of change (Grade I: right ventricular hypertrophy; Grade II: I + right ventricular dilation; Grade III: II + Dilation of the inferior vena cava). Echocardiographic investigation, at least from the subcostal view, and grading was possible in all patients. A correlation was found between the echocardiographic grading and the mean pulmonary artery pressure (PAP)-normal echo study 15.7 +/- 4.8; grade I 21.1 +/- 5.6; grade II 28.8 +/- 10.2; grade III 39.4 +/- 9.4 mmHg. In addition, patients with stress-induced pulmonary hypertension (PHT) were detected by Doppler echocardiography. 6 of 11 patients with latent PHT already showed evidence of cor pulmonale (4 Grade I and 2 Grade II). In 42 patients (61%) the systolic PAP was estimated by measuring the velocity of the tricuspid insufficiency jet with Doppler, and these data correlated closely with the invasive data (p < 0.001; r = 0.81). Doppler echocardiography for evaluation of cor pulmonale is feasible even in patients with chronic lung disease and limited acoustic windows. Semiquantitative grading correlates well with invasive data. Here, this technique is useful as a baseline study as well as for the follow-up of patients with chronic lung disease.

[Use of captopril in the treatment of chronic cor pulmonale]. / Primenenie kaptoprila pri lechenii khronicheskogo legochnogo serdtsa.

Captopril administration in chronic cor pulmonale (CCP) stage I and II produced positive objective and subjective responses evident from a significant improvement of right heart myocardial contractility, external respiration which lower systolic pressure in the artery. Captopril can be introduced in CCP stage I for preventive and CCP stage II for therapeutic purposes.