Right ventricular–pulmonary arterial coupling in patients after repair of tetralogy of Fallot

Latus, Heiner; Binder, Wolfhard; Kerst, Gunter; Hofbeck, Michael; Sieverding, Ludger; Apitz, Christian

doi:10.1016/j.jtcvs.2013.02.039

Cited by 43 publications

(39 citation statements)

References 27 publications

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“…Latus and colleagues demonstrated that patients with TOF and chronic PR had impaired RV‐PA coupling both at rest and with dobutamine stress based on invasive hemodynamic assessment in 24 patients . Although the RV end‐systolic elastance increased with dobutamine stress, there was a disproportionate increase in PA elastance resulting in a decrease in RV‐PA coupling (RV‐PA uncoupling) in TOF patients . A very important observation in that study was that the patients that had more impaired RV‐PA coupling at rest tended to have more RV‐PA “uncoupling” with dobutamine stress because of disproportionate increase in PA elastance .…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…Quantitative RV volumetric assessment by echocardiography is challenging because of its complex geometry, and as a result cardiac magnetic resonance imaging (CMRI) has become the most commonly used modality for RV volumetric assessment . Right ventricular to pulmonary arterial (RV‐PA) coupling is a load‐independent measure of RV performance, which incorporates both RV systolic function and PA vascular function . Although RV‐PA coupling is typically measured by invasive cardiac catheterization, several studies have demonstrated the feasibility and prognostic value of noninvasively measured RV‐PA coupling in patients with heart failure due to acquired heart disease .…”

Section: Introductionmentioning

confidence: 99%

“…6 Right ventricular to pulmonary arterial (RV-PA) coupling is a load-independent measure of RV performance, which incorporates both RV systolic function and PA vascular function. 9 Although RV-PA coupling is typically measured by invasive cardiac catheterization, several studies have demonstrated the feasibility and prognostic value of noninvasively measured RV-PA coupling in patients with heart failure due to acquired heart disease. [10][11][12][13] This concept has not been studied in adults with congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

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

Egbe

Miranda

Pellikka

et al. 2019

Congenital Heart Disease

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Background We hypothesized that echocardiographic indices of right ventricular to pulmonary artery (RV‐PA) coupling were comparable to cardiac magnetic resonance imaging (CMRI)‐derived RV volumetric indices in predicting disease severity in chronic pulmonary regurgitation (PR). Methods Patients with ≥ moderate PR (2003‐2015) with and without prior CMRI scans were enrolled into the study cohort and validation cohort, respectively. Endpoint was to determine the association between noninvasive RV‐PA coupling indices (tricuspid annular plane systolic excursion/right ventricular systolic pressure [TAPSE/RVSP] and fractional area change [FAC]/RVSP ratio) and markers of disease severity, and compared this association to that of CMRI‐derived RV volumetric indices and markers of disease severity (peak oxygen consumption [VO2], NT‐proBNP and atrial and/or ventricular arrhythmias). Results Of the 256 patients in the study cohort (age 33 ± 6 years), 187 (73%) had tetralogy of Fallot (TOF) while 69 (27%) had valvular pulmonic stenosis (VPS). TAPSE/RVSP (r = 0.73, P < .001) and FAC/RVSP (r = 0.78, P < .001) correlated with peak VO2. Among the CMRI‐derived RV volumetric indices analyzed, only right ventricular end‐systolic volume index correlated with peak VO2 (r = −0.54, P < .001) and NT‐proBNP (r = 0.51, P < .001). These RV‐PA coupling indices were tested in the validation cohort of 218 patients (age 37 ± 9 years). Similar to the study cohort, TAPSE/RVSP (r = 0.59, P < .001) and FAC/RVSP (r = 0.70, P < .001) correlated with peak VO2. TAPSE/RVSP (but not FAC/RVSP) was also associated with arrhythmia occurrence in both the study cohort and validation cohorts. Conclusion Noninvasive RV‐PA coupling may provide complementary prognostic data in the management of chronic PR. Further studies are required to explore this clinical tool.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Egbe

Miranda

Pellikka

et al. 2019

Congenital Heart Disease

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“…24 Right-to-left resynchronization of diastole has been shown to improve RV stroke volume in a patient population with chronic thromboembolic pulmonary hypertension, assessed by conductance, indicating the importance of ventricular coupling via the shared septum influencing RV performance. 24 Right-to-left resynchronization of diastole has been shown to improve RV stroke volume in a patient population with chronic thromboembolic pulmonary hypertension, assessed by conductance, indicating the importance of ventricular coupling via the shared septum influencing RV performance.…”

Section: Right Ventricular Assessment Using Conductance: Historical Amentioning

confidence: 99%

Right Ventricle Functional Assessment

McCabe

White

Rana

et al. 2014

Cardiology in Review

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This review explores the historical development of conductance catheterization of the human right ventricle (RV) and its current diagnostic role in assessing RV function in an era of contemporary noninvasive imaging. Significant advances in echocardiography, cardiothoracic computed tomography, and cardiac magnetic resonance in the last decade have led a paradigm shift away from invasive hemodynamic assessment toward noninvasive measurement of RV function. However, imaging modalities are not without some disadvantages. For example, they do not provide the beat-to-beat pressure-volume assessment that is obtained by conductance catheterization, which is still arguably the gold standard for measuring cardiac performance. Right heart catheterization remains an integral part of the assessment of patients with RV dysfunction, and a burgeoning interest in early RV insufficiency in a range of cardiopulmonary diseases has brought the detailed interrogation of RV function back into focus. Although conductance volume assessment of the RV is more limited than the left ventricle, the scope for improving the understanding of RV adaptation to pulmonary and valvular pathologies and RV myocardial disease by using a conductance catheter still exists. We review the up-to-date functional applications of echocardiography and computed tomography/cardiac magnetic resonance to assess the RV and illustrate the potential of contemporary conductance catheter techniques to complement noninvasive imaging in the assessment of RV function.

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The impact of unilateral pulmonary artery stenosis on right ventricular to pulmonary arterial coupling in patients with transposition of the great arteries

Joosen,

Voskuil,

Krings

et al. 2024

Cathet Cardio Intervent

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BackgroundUnilateral pulmonary artery (PA) stenosis is common in the transposition of the great arteries (TGA) after arterial switch operation (ASO) but the effects on the right ventricle (RV) remain unclear.AimsTo assess the effects of unilateral PA stenosis on RV afterload and function in pediatric patients with TGA‐ASO.MethodsIn this retrospective study, eight TGA patients with unilateral PA stenosis underwent heart catheterization and cardiac magnetic resonance (CMR) imaging. RV pressures, RV afterload (arterial elastance [Ea]), PA compliance, RV contractility (end‐systolic elastance [Ees]), RV‐to‐PA (RV‐PA) coupling (Ees/Ea), and RV diastolic stiffness (end‐diastolic elastance [Eed]) were analyzed and compared to normal values from the literature.ResultsIn all TGA patients (mean age 12 ± 3 years), RV afterload (Ea) and RV pressures were increased whereas PA compliance was reduced. RV contractility (Ees) was decreased resulting in RV‐PA uncoupling. RV diastolic stiffness (Eed) was increased. CMR‐derived RV volumes, mass, and ejection fraction were preserved.ConclusionUnilateral PA stenosis results in an increased RV afterload in TGA patients after ASO. RV remodeling and function remain within normal limits when analyzed by CMR but RV pressure–volume loop analysis shows impaired RV diastolic stiffness and RV contractility leading to RV‐PA uncoupling.

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Right ventricular–pulmonary arterial coupling in patients after repair of tetralogy of Fallot

Cited by 43 publications

References 27 publications

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

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

Right Ventricle Functional Assessment

The impact of unilateral pulmonary artery stenosis on right ventricular to pulmonary arterial coupling in patients with transposition of the great arteries

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