Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation

Egbe, Alexander C.; Miranda, William R.; Pellikka, Patricia A.; Pislaru, Sorin V.; Borlaug, Barry A.; Kothapalli, Srikanth; Ananthaneni, Sindhura; Sandhyavenu, Harigopal; Najam, Maria; Abdelsamid, Mohamed Farouk; Connolly, Heidi M.

doi:10.1111/chd.12768

Cited by 18 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All models were adjusted for age, age at TOF repair, sex, type of TOF repair (transannular patch repair vs. others), TOF-pulmonary atresia diagnosis, RV systolic dysfunction, tricuspid regurgitation velocity, tricuspid and pulmonary regurgitation severity, left ventricular ejection fraction, and QRS duration because of known association with clinical outcomes in this population. 1,14 We used manual backwards stepwise model selection based on likelihood ratio P value, with P < 0.25 required for entry and P < 0.1 required to remain in the model. A P < 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…We assessed disease severity using four indices as previously described 14 : (i) atrial arrhythmias were defined as atrial fibrillation, atrial tachycardia, or atrial flutter; (ii) ventricular arrhythmias were defined as sustained or non‐sustained ventricular tachycardia; (iii) heart failure hospitalization was defined as hospitalization for volume overload requiring intravenous diuretics; and (iv) per cent predicted peak oxygen consumption (VO 2 ) was determined by cardiopulmonary exercise test. Heart transplant and death (all‐cause mortality) were ascertained from the medical records and Accurint database in 100% of the patients as of 31 December 2018.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic implications of inferior vena cava haemodynamics in ambulatory patients with tetralogy of Fallot

et al. 2020

Self Cite

View full text Add to dashboard Cite

Aims Right atrial pressure (RAP) provides a composite measure of right ventricular diastolic dysfunction, right atrial compliance, and volume status, and these three variables are typically abnormal in adults with repaired tetralogy of Fallot (TOF). RAP is a well-established prognostic metric in patients with pulmonary hypertension, and recent data suggest that RAP is associated with clinical outcomes in TOF. The purpose of this study was to determine the role of inferior vena cava (IVC) haemodynamics (size and collapsibility) for the assessment of RAP and its potential application for risk stratification and prognostication in the TOF population. Methods and results Adult TOF patients with echocardiographic assessment of IVC haemodynamics were divided into patients with (derivation cohort, n = 256) and without (validation cohort, n = 492) cardiac catheterization data. We assessed the correlation between IVC haemodynamics, RAP, and disease severity indices [arrhythmias, peak oxygen consumption (VO 2), and heart failure hospitalization] in derivation cohort and compared it with the correlations in the validation cohort. IVC haemodynamics correlated with RAP (r = 0.52, P < 0.001), with disease severity indices {atrial arrhythmias [area under the curve (AUC) 0.81], ventricular arrhythmias [AUC 0.67], heart failure hospitalizations [AUC 0.78], and peak VO 2 [r = 0.53]}, and with transplant-free survival in the derivation cohort. Similar correlations between IVC haemodynamics, disease severity indices, and transplant-free survival were also observed in the validation cohort. Conclusions These findings suggest that IVC haemodynamics can potentially be used for risk stratification and prognostication in TOF patients and can complement the current risk models that are based predominately on right ventricular volumes and systolic function.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic implications of inferior vena cava haemodynamics in ambulatory patients with tetralogy of Fallot

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…A reduction in RV-PA coupling caused by a disproportionate increase in PA elastance highlighted the important role of abnormal PA elastic properties and its potential interaction with RV-PA coupling in TOF and VPS patients with PR [ 40 ]. Additionally, investigators aimed to determine the association between noninvasive RV-PA coupling indices (TAPSE/RVSP and FAC/RVSP ratio) and disease severity in TOF patients, and compared this association to peak oxygen consumption [ 102 ]. They found that RV-PA coupling was modestly correlated with peak oxygen consumption in patients with TOF.…”

Section: Clinical Applications Of Rv-pa Couplingmentioning

confidence: 99%

Clinical Usefulness of Right Ventricle–Pulmonary Artery Coupling in Cardiovascular Disease

Zhu

Gao

et al. 2023

JCM

View full text Add to dashboard Cite

Right ventricular–pulmonary artery coupling (RV-PA coupling) refers to the relationship between RV contractility and RV afterload. Normal RV-PA coupling is maintained only when RV function and pulmonary vascular resistance are appropriately matched. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure. RV-PA coupling plays an important role in the pathophysiology and progression of cardiovascular diseases. Therefore, early and accurate evaluation of RV-PA coupling is of great significance for a patient’s condition assessment, clinical decision making, risk stratification, and prognosis judgment. RV-PA coupling can be assessed by using invasive or noninvasive approaches. The aim of this review was to summarize the pathological mechanism and evaluation methods of RV-PA coupling, the advantages and disadvantages of each method, and the application value of RV-PA coupling in various cardiovascular diseases.

show abstract

“…Egbe et al found TAPSE/PASP and RVFAC/PASP to correlate with exercise capacity (peak oxygen uptake) and occurrence of relevant arrhythmias in tetralogy of Fallot and pulmonary stenosis with pulmonary regurgitation, consequently reflecting disease severity. 55…”

Section: Paediatrics and Congenital Heart Diseasementioning

confidence: 99%

Adaptive versus maladaptive right ventricular remodelling

et al. 2022

View full text Add to dashboard Cite

Right ventricular (RV) function and its adaptation to increased afterload [RV–pulmonary arterial (PA) coupling] are crucial in various types of pulmonary hypertension, determining symptomatology and outcome. In the course of disease progression and increasing afterload, the right ventricle undergoes adaptive remodelling to maintain right‐sided cardiac output by increasing contractility. Exhaustion of compensatory RV remodelling (RV–PA uncoupling) finally leads to maladaptation and increase of cardiac volumes, resulting in heart failure. The gold‐standard measurement of RV–PA coupling is the ratio of contractility [end‐systolic elastance (Ees)] to afterload [arterial elastance (Ea)] derived from RV pressure–volume loops obtained by conductance catheterization. The optimal Ees/Ea ratio is between 1.5 and 2.0. RV–PA coupling in pulmonary hypertension has considerable reserve; the Ees/Ea threshold at which uncoupling occurs is estimated to be ~0.7. As RV conductance catheterization is invasive, complex, and not widely available, multiple non‐invasive echocardiographic surrogates for Ees/Ea have been investigated. One of the first described and best validated surrogates is the ratio of tricuspid annular plane systolic excursion to estimated pulmonary arterial systolic pressure (TAPSE/PASP), which has shown prognostic relevance in left‐sided heart failure and precapillary pulmonary hypertension. Other RV–PA coupling surrogates have been formed by replacing TAPSE with different echocardiographic measures of RV contractility, such as peak systolic tissue velocity of the lateral tricuspid annulus (S′), RV fractional area change, speckle tracking‐based RV free wall longitudinal strain and global longitudinal strain, and three‐dimensional RV ejection fraction. PASP‐independent surrogates have also been studied, including the ratios S′/RV end‐systolic area index, RV area change/RV end‐systolic area, and stroke volume/end‐systolic volume. Limitations of these non‐invasive surrogates include the influence of severe tricuspid regurgitation (which can cause distortion of longitudinal measurements and underestimation of PASP) and the angle dependence of TAPSE and PASP. Detection of early RV remodelling may require isolated analysis of single components of RV shortening along the radial and anteroposterior axes as well as the longitudinal axis. Multiple non‐invasive methods may need to be applied depending on the level of RV dysfunction. This review explains the mechanisms of RV (mal)adaptation to its load, describes the invasive assessment of RV–PA coupling, and provides an overview of studies of non‐invasive surrogate parameters, highlighting recently published works in this field. Further large‐scale prospective studies including gold‐standard validation are needed, as most studies to date had a retrospective, single‐centre design with a small number of participants, and validation against gold‐standard Ees/Ea was rarely performed.

show abstract

Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation

Cited by 18 publications

References 31 publications

Prognostic implications of inferior vena cava haemodynamics in ambulatory patients with tetralogy of Fallot

Prognostic implications of inferior vena cava haemodynamics in ambulatory patients with tetralogy of Fallot

Clinical Usefulness of Right Ventricle–Pulmonary Artery Coupling in Cardiovascular Disease

Adaptive versus maladaptive right ventricular remodelling

Contact Info

Product

Resources

About