Right ventricular-vascular coupling ratio in pediatric pulmonary arterial hypertension: A comparison between cardiac magnetic resonance and right heart catheterization measurements

Breeman, Karel; Dufva, Melanie J; Ploegstra, Mark‐Jan; Kheyfets, Vitaly O.; Willems, Tineke P.; Wigger, Joachim; Hunter, Kendall S.; Ivy, D. Dunbar; Berger, R.; Truong, Uyen

doi:10.1016/j.ijcard.2019.05.021

Cited by 16 publications

(15 citation statements)

References 32 publications

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“…A cutoff of 0.805 was defined for the onset of RV dilation and failure (defined as ejection fraction <35%), demonstrating a significant reserve for RV-PA coupling before progression to RV failure (Tello et al, 2019a). Another clinical study demonstrated that RV-PA coupling is an independent predictor of survival in PH (Vanderpool et al, 2015), which has been confirmed by several other studies (Brewis et al, 2016;Breeman et al, 2019;Jone et al, 2019;Hsu et al, 2020).…”

Section: Effects Of Pah On Rv-pa Couplingmentioning

confidence: 84%

Current Understanding of the Right Ventricle Structure and Function in Pulmonary Arterial Hypertension

2021

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Pulmonary arterial hypertension (PAH) is a disease resulting in increased right ventricular (RV) afterload and RV remodeling. PAH results in altered RV structure and function at different scales from organ-level hemodynamics to tissue-level biomechanical properties, fiber-level architecture, and cardiomyocyte-level contractility. Biomechanical analysis of RV pathophysiology has drawn significant attention over the past years and recent work has found a close link between RV biomechanics and physiological function. Building upon previously developed techniques, biomechanical studies have employed multi-scale analysis frameworks to investigate the underlying mechanisms of RV remodeling in PAH and effects of potential therapeutic interventions on these mechanisms. In this review, we discuss the current understanding of RV structure and function in PAH, highlighting the findings from recent studies on the biomechanics of RV remodeling at organ, tissue, fiber, and cellular levels. Recent progress in understanding the underlying mechanisms of RV remodeling in PAH, and effects of potential therapeutics, will be highlighted from a biomechanical perspective. The clinical relevance of RV biomechanics in PAH will be discussed, followed by addressing the current knowledge gaps and providing suggested directions for future research.

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Section: Effects Of Pah On Rv-pa Couplingmentioning

confidence: 84%

Current Understanding of the Right Ventricle Structure and Function in Pulmonary Arterial Hypertension

2021

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“…They also noted that VA uncoupling was already present in non-responders to NO suggesting that this concept is particularly valuable to serially follow PH patients over time (70). In an extension of their previous study and including data from a second pediatric PH centre, this group demonstrated that both invasively and noninvasively assessed VAC correlated with functional and hemodynamic measures of disease severity (29).…”

Section: Rv-pulmonary Arterial Couplingmentioning

confidence: 85%

Role of cardiovascular magnetic resonance in pediatric pulmonary hypertension—novel concepts and imaging biomarkers

Latus

Meierhofer

2021

Cardiovasc Diagn Ther

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Pulmonary hypertension (PH) in children is a heterogenous disease of the small pulmonary arteries characterized by a progressive increase in pulmonary vascular resistance. Despite adequate medical therapy, long-term pressure overload is frequently associated with a progressive course leading to right ventricular failure and ultimately death. Invasive hemodynamic assessment by cardiac catheterization is crucial for initial diagnosis, risk stratification and therapeutic strategy. Although echocardiography remains the most important imaging modality for the assessment of right ventricular function and pulmonary hemodynamics, cardiovascular magnetic resonance (CMR) has emerged as a valuable non-invasive imaging technique that enables comprehensive evaluation of biventricular performance, blood flow, morphology and the myocardial tissue. In this review, we summarize the principles and applications of CMR in the evaluation of pediatric PH patients and present an update about novel CMR based concepts and imaging biomarkers that may provide further diagnostic, therapeutic and prognostic information.

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“…Despite this, VVCR CMR remains a valuable tool, especially when followed longitudinally. In adults and children, both VVCR CMR and VVCR RHC correlated well with conventional functional and hemodynamic parameters of disease severity (96,98), as well as clinical deterioration (99) and transplant-free survival (100). Impaired right ventricular-vascular coupling in PH is likely to be a gradual and progressive feature and serial imaging could guide the clinician in this process.…”

Section: Ventricular Vascular Coupling (Vvc)mentioning

confidence: 88%

“…Conventionally, VVCR is measured by cardiac catheterization, with progressively decreasing preload achieved by obstructing flow through the inferior vena cava-a time-consuming and invasive methodology, not to mention impossible in very young children secondary to the size of the catheter used. Sanz showed that VVCR can be estimated using only MRI data (VVCR CMR ) and is calculated as SV/ESV (96), and correlates to VVCR derived by the catheterization-based single beat (VVCR RHC ) method (97,98). It is important to understand that this estimation assumes zero intercept of the ventricular elastance curve which limits its accuracy.…”

Section: Ventricular Vascular Coupling (Vvc)mentioning

confidence: 99%

Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension

Truong

Meinel

Haddad

et al. 2020

Cardiovasc Diagn Ther

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Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span.The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.

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Right ventricular-vascular coupling ratio in pediatric pulmonary arterial hypertension: A comparison between cardiac magnetic resonance and right heart catheterization measurements

Cited by 16 publications

References 32 publications

Current Understanding of the Right Ventricle Structure and Function in Pulmonary Arterial Hypertension

Current Understanding of the Right Ventricle Structure and Function in Pulmonary Arterial Hypertension

Role of cardiovascular magnetic resonance in pediatric pulmonary hypertension—novel concepts and imaging biomarkers

Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension

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