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Lung & Heart interaction

Heart and lung diseases are important causes of morbidity and mortality. Both diseases have a high prevalence and occur with a substantial overlap. This raises the question whether the coexistence is based on common shared risk factors or whether there are other links beyond. While an increased right heart load is well understood in various pulmonary diseases, dedicated changes of the left heart are largely unknown.
 
It is thus aimed to examine interactions between the lung and the left heart in chronic obstructive pulmonary disease (COPD). Therefore, heart imaging based on echocardiography, magnetic resonance imaging (MRI) and computed tomography (CT) is used to assess systolic and diastolic cardiac function, heart size and morphology. Left ventricular wall stress is calculated using a thick-walled sphere model of the left ventricle.
 
animated_lung

Causes 

  • Airway resistance 
  • Hyperinflation 
  • Vascular resistance 

Consequences 

  • Intrathoracic pressure 
  • Cardiac distending forces 
  • Venous return 
 
Beside monocentric studies, also large data sets from the German COPD cohort COSYCONET, a prospective, observational, multicenter cohort study in patients with COPD that is being conducted in major clinics and pulmonology centers across Germany, are examined.
 

Heart Imaging & Wall Stress

Heart imaging based on echocardiography, magnetic resonance imaging (MRI) and computed tomography (CT) is used to assess heart size and systolic and diastolic cardiac function. Using dedicated acquisition sequences, particularly MRI provides various information on myocardial structure and morphology, e.g. edema and diffuse or local fibrosis. MRI is the gold standard to measure cardiac size. Left ventricular volumes and myocardial mass can be assessed with high accuracy and reproducibility.

Based on these measurements, wall stress is calculated using a thick walled sphere model of the left ventricle that is derived from the law of LaPlace and allows arbitrary wall diameters. Wall stress appears to be a crucial prognostic determinant, i.e. increased wall stress propagates the vicious circle of ongoing ventricular dilatation in heart failure and is associated with an increased arrhythmia risk following activation of stretch-associated myocardial ion channels. Thus, examination of wall stress has been envisaged as crucial prognostic determinant that requires further research.

Wall Stress of the Heart

Kugelmodell
 
Thick-walled sphere model that is used to calculate left ventricular wall stress. The model is derived from the law of LaPlace and allows wall stress calculation for arbitrary wall diameters.


Therefore, the wall stress index (σi) was introduced.
Formel Wandspannung

Increased wall stress is associated with variety of adverse consequences, e.g. propagation of the vicious circle of heart failure and dilatation, and the arrhythmia risk is increased by opening of stretch-activated cardiomyocyte ion channels. This may be associated with an unfavourable prognosis.

Stretch activated Ion Channels

Zuletzt aktualisiert: 09.04.2019 · speichet

 
 
 
Fb. 20 - Medizin

Pneumologie, Baldingerstraße, D-35043 Marburg
Tel. +49 6421/58-66451, Fax +49 6421/58-68987, E-Mail: Claus.Vogelmeier@med.uni-marburg.de

URL dieser Seite: https://www.uni-marburg.de/fb20/pneumologie/forschung/lung_heart

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