Mechanisms of oxygen demand/supply balance in the right ventricle

Pu Zong, Johnathan D. Tune, H. Fred Downey

Research output: Contribution to journalShort survey

66 Scopus citations

Abstract

Few studies have investigated factors responsible for the O2 demand/supply balance in the right ventricle. Resting right coronary blood flow is lower than left coronary blood flow, which is consistent with the lesser work of the right ventricle. Because right and left coronary artery perfusion pressures are identical, right coronary conductance is less than left coronary conductance, but the signal relating this conductance to the lower right ventricular O2 demand has not been defined. At rest, the left ventricle extracts ∼75% of the O2 delivered by coronary blood flow, whereas right ventricular O2 extraction is only ∼50%. As a result, resting right coronary venous PO2 is ∼30 mm Hg, whereas left coronary venous PO2 is ∼20 mm Hg. Right coronary conductance does not sufficiently restrict flow to force the right ventricle to extract the same percentage of O2 as the left ventricle. Endogenous nitric oxide impacts the right ventricular O2 demand/supply balance by increasing the right coronary blood flow at rest and during acute pulmonary hypertension, systemic hypoxia, norepinephrine infusion, and coronary hypoperfusion. The substantial right ventricular O2 extraction reserve is used preferentially during exercise-induced increases in right ventricular myocardial O2 consumption. An augmented, sympathetic-mediated vasoconstrictor tone blunts metabolically mediated dilator mechanisms during exercise and forces the right ventricle to mobilize its O2 extraction reserve, but this tone does not limit resting right coronary flow. During exercise, right coronary vasodilation does not occur until right coronary venous PO2 decreases to ∼20 mm Hg. The mechanism responsible for right coronary vasodilation at low PO2 has not been delineated. In the poorly autoregulating right coronary circulation, reduced coronary pressure unloads the coronary hydraulic skeleton and reduces right ventricular systolic stiffness. Thus, normal right ventricular external work and O2 demand/supply balance can be maintained during moderate coronary hypoperfusion.

Original languageEnglish (US)
Pages (from-to)507-519
Number of pages13
JournalExperimental Biology and Medicine
Volume230
Issue number8
DOIs
StatePublished - Sep 2005

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Keywords

  • Contractile function
  • Coronary circulation
  • Myocardial oxygen consumption
  • Oxygen extraction reserve
  • Right ventricle

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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