Prognostic Role of Pulmonary Arterial Capacitance in Advanced Heart Failure

Dupont, Matthias; Mullens, Wilfried; Skouri, Hadi; Abrahams, Zuheir; Wu, Yuping; Taylor, David O.; Starling, Randall C.; Tang, W.H. Wilson

doi:10.1161/circheartfailure.112.968511

Cited by 127 publications

(126 citation statements)

References 22 publications

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“…Recently, TEDFORD et al [22] documented shortened empiric RC-times in post-capillary PH, thus suggesting an increased pulsatile afterload when compared to precapillary PH at a given level of PVR. This has been subsequently confirmed by other authors [23][24][25]. These studies still documented an inverse hyperbolic relationship between PVR and SV/Papp, and supported the concept that the mean PVR×C product was in the 0.25-0.53 s range in post-capillary PH [22][23][24][25].…”

Section: Conflicting Results On Rc-time Value In Health and Diseasessupporting

confidence: 71%

“…This has been subsequently confirmed by other authors [23][24][25]. These studies still documented an inverse hyperbolic relationship between PVR and SV/Papp, and supported the concept that the mean PVR×C product was in the 0.25-0.53 s range in post-capillary PH [22][23][24][25]. Very recently, TEDFORD [26] has further challenged the paradigm of constant RC-times in normotensive subjects versus PAH patients.…”

Section: Conflicting Results On Rc-time Value In Health and Diseasesmentioning

confidence: 57%

“…In congestive heart failure patients, SV/PApp provides stronger prediction than PVR (univariate analysis), and SV/PApp remains an independent predictor with multivariate analysis while PVR does not [23]. It has been suggested that SV/PApp is an integrated measure of RV afterload that may be superior to PVR in explaining RV failure and in predicting adverse outcomes in the setting of left-sided heart failure [23,66]. SV/Papp can also be viewed as lumped parameter that takes into account the contributions of wave reflections and pulsatile load because of the inclusion of PApp in its denominator.…”

Section: Resistance-compliance Relationship Of the Pulmonary Circulationmentioning

confidence: 96%

“…2) [27]. In post-capillary PH, RC-time decreases linearly with increasing left atrial pressure [22][23][24]. Finally, in precapillary PH, it has been suggested that at high values of PVR, compliance reaches a minimum and that further increases in PVR would result in an increase in RC-time [17].…”

Section: Rc-time: a Critical Evaluation And New Proposalmentioning

confidence: 99%

“…A constant RC-time product has important implications for the assessment of RV afterload, namely that PVR and total arterial compliance are redundant measurements and knowledge of one enables the derivation of the other. Exceptions to the constant RC-time product have recently been documented, for example in PH-related to left heart disease [22][23][24][25], prompting a re-evaluation of the concept of RC-time constancy [26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

et al. 2015

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Right ventricular adaptation to the increased pulmonary arterial load is a key determinant of outcomes in pulmonary hypertension (PH). Pulmonary vascular resistance (PVR) and total arterial compliance (C) quantify resistive and elastic properties of pulmonary arteries that modulate the steady and pulsatile components of pulmonary arterial load, respectively. PVR is commonly calculated as transpulmonary pressure gradient over pulmonary flow and total arterial compliance as stroke volume over pulmonary arterial pulse pressure (SV/PApp). Assuming that there is an inverse, hyperbolic relationship between PVR and C, recent studies have popularised the concept that their product (RC-time of the pulmonary circulation, in seconds) is "constant" in health and diseases. However, emerging evidence suggests that this concept should be challenged, with shortened RC-times documented in post-capillary PH and normotensive subjects. Furthermore, reported RC-times in the literature have consistently demonstrated significant scatter around the mean. In precapillary PH, the true PVR can be overestimated if one uses the standard PVR equation because the zero-flow pressure may be significantly higher than pulmonary arterial wedge pressure. Furthermore, SV/PApp may also overestimate true C. Further studies are needed to clarify some of the inconsistencies of pulmonary RC-time, as this has major implications for our understanding of the arterial load in diseases of the pulmonary circulation. @ERSpublications Empiric estimates of pulmonary arterial load are prone to errors and may result in overestimation of RC-time

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Section: Conflicting Results On Rc-time Value In Health and Diseasessupporting

confidence: 71%

Section: Conflicting Results On Rc-time Value In Health and Diseasesmentioning

confidence: 57%

Section: Resistance-compliance Relationship Of the Pulmonary Circulationmentioning

confidence: 96%

Section: Rc-time: a Critical Evaluation And New Proposalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

et al. 2015

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Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

et al. 2019

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Aims The study evaluated exercise left ventricular global longitudinal strain (LVGLS) and invasive haemodynamics for major adverse cardiac events (MACE) prediction in heart‐transplanted (HTx) patients. Methods and results The study comprised 74 stable consecutive HTx patients who were followed at the Department of Cardiology, Aarhus University Hospital, Denmark, from August 2013 to January 2017. All patients were transplanted a minimum of 12 months before study entry and were included at the time of their routine annual coronary angiography. A symptom‐limited haemodynamic exercise test with simultaneous echocardiographic study was performed. The primary endpoint was MACE during follow‐up defined as heart failure hospitalization, treated rejection episodes, coronary event, or cardiac death. The median time since transplant was 5 years [1:12] and the median follow‐up was 1095 days [391;1506]. Thirty patients (41%) experienced MACE during follow‐up. Patients who suffered MACE had an impaired resting and peak exercise systolic function in form of a lower LV ejection fraction (Rest: 56 ± 12% vs. 65 ± 7%, P < 0.001; Peak 64 ± 13% vs. 72 ± 6%, P < 0.01) and LVGLS (Rest: 13 ± 4% vs. 16 ± 2%, P < 0.01; Peak: 15 ± 6% vs. 20 ± 4%, P = 0.0001) than patients without MACE episodes. In contrast, resting diastolic filling patterns were comparable between patients suffering from MACE and patients without MACE. At rest, pulmonary capillary wedge pressure (mPCWP) and cardiac index did not predict MACE, whereas increased right atrial pressure (mRAP) was associated with increased MACE risk. Patients with peak exercise mPCWP >23 mmHg [hazard ratio (HR) 2.5, 95% confidence interval (CI): 1.2–5.4], cardiac index <5.9 L/min/m2 (HR 2.7, 95% CI: 1.0–6.3), or mRAP >13 mmHg (HR 2.7, 95% CI: 1.1–6.3) had increased MACE risk. Patients with exercise‐induced LVGLS increase <3.5% and peak exercise cardiac index <5.9 L/min/m2 [HR 6.1 (95% CI: 2.2–17.1)] or mPCWP >23 mmHg [HR 6.1 (95% CI: 2.1–17.5)] or mRAP >13 mmHg [HR 7.5 (95% CI: 2.3–23.9)] had the highest MACE risk. Conclusions Resting haemodynamic parameters were poor MACE predictors in long‐term HTx patients. In contrast, peak exercise mPCWP, mRAP, and CI were significant MACE predictors. LVGLS both at rest and during exercise were significant MACE predictors, and the combined model with peak exercise LVGLS and peak exercise mPCWP, mRAP, and CI clearly identified high‐risk HTx patients in relation cardiovascular endpoints independently of time since HTx.

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Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

et al. 2021

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Aims Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV-pulmonary artery (PA) coupling, is defined by the ratio of RV end-systolic to PA elastances (Ees/Ea). Using pressure-volume loop (PV-L) technique we aimed to identify an Ees/Ea cut-off predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to heart failure with reduced ejection fraction (HFREF). Methods and resultsThis post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography and a baseline PV-L and RV catheter measurement. A subgroup of patients (n = 50) without a pre-implanted cardiac device underwent magnetic resonance imaging at baseline. The analysis revealed that 0.68 is an optimal Ees/Ea cut-off (area under the curve: 0.697, P < 0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥ 0.68 vs. <0.68, log-rank 8.9, P = 0.003). In patients with PH (n = 76, 68%) multivariate Cox regression demonstrated the independent prognostic value of RV-Ees/Ea in PH patients (hazard ratio 0.2, P < 0.038). Patients without PH (n = 36, 32%) and those with PH but RV-Ees/Ea ≥ 0.68 showed comparable RV-Ees/Ea ratios (0.88 vs. 0.9, P = 0.39), RV size/function, and survival. In contrast, secondary PH with RV-PA coupling ratio Ees/Ea < 0.68 corresponded extremely close to cut-off values that define RV dilatation/remodelling (RV end-diastolic volume >160 mL, RV-mass/volume-ratio ≤0.37 g/mL) and dysfunction (right ventricular ejection fraction <38%, tricuspid annular plane systolic excursion <16 mm, fractional area change <42%, and stroke-volume/end-systolic volume ratio <0.59) and is associated with a dramatically increased short and medium-term all-cause mortality. Independent predictors of prognostically unfavourable RV-PA coupling (Ees/Ea < 0.68) in secondary PH were a pre-existent dilated RV [end-diastolic volume >171 mL, odds ratio (OR) 0.96, P = 0.021], high pulsatile load (PA compliance <2.3 mL/mmHg, OR 8.6, P = 0.003), and advanced systolic left heart failure (left ventricular ejection fraction <30%, OR 1.23, P = 0.028). Conclusions The RV-PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodelling, and left ventricular dysfunction. Prognostically favourable coupling (RV-Ees/Ea ≥ 0.68) in PH was associated with preserved RV size/function and mid-term survival, comparable with HFREF without PH.

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Prognostic Role of Pulmonary Arterial Capacitance in Advanced Heart Failure

Cited by 127 publications

References 22 publications

Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

Pulmonary vascular resistance and compliance relationship in pulmonary hypertension

Prognostic value of exercise myocardial deformation and haemodynamics in long‐term heart‐transplanted patients

Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

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