Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study

Sanz, Javier; García‐Álvarez, Ana; Fernández‐Friera, Leticia; Nair, Ajith; Mirelis, J. González; Sawit, Simonette T; Pinney, Sean; Fuster, Valentín

doi:10.1136/heartjnl-2011-300462

Cited by 263 publications

(248 citation statements)

References 40 publications

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“…[23][24][25][26] In a subgroup of patients (n = 8) who had cardiac magnetic resonance imaging (MRI), we also estimated RV-PA coupling using cardiac MRI-based volume method defined as endsystolic volume divided by stroke volume. 27,28 Table S1 lists the 3 formulae used to estimate RV-PA coupling.…”

Section: Right Ventricular Function and Rv-pa Couplingmentioning

confidence: 99%

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

et al. 2016

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Pulmonary pulse wave transit time (pPTT), defined as the time for the systolic pressure pulse wave to travel from the pulmonary valve to the pulmonary veins, has been reported to be reduced in pulmonary arterial hypertension (PAH); however, the underlying mechanism of reduced pPTT is unknown. Here, we investigate the hypothesis that abbreviated pPTT in PAH results from impaired right ventricular-pulmonary artery (RV-PA) coupling. We quantified pPTT using pulsed-wave Doppler ultrasound from 10 healthy age-and sexmatched controls and 36 patients with PAH. pPTT was reduced in patients with PAH compared with controls. Univariate analysis revealed the following significant predictors of reduced pPTT: age, right ventricular fractional area change (RV FAC), tricuspid annular plane excursion (TAPSE), pulmonary arterial pressures (PAP), diastolic pulmonary gradient, transpulmonary gradient, pulmonary vascular resistance, and RV-PA coupling (defined as RV FAC/mean PAP or TAPSE/mean PAP). Although the correlations between pPTT and invasive markers of pulmonary vascular disease were modest, RV FAC (r = 0.64, P < 0.0001), TAPSE (r = 0.67, P < 0.0001), and RV-PA coupling (RV FAC/mean PAP: r = 0.72, P < 0.0001; TAPSE/mean PAP: r = 0.74, P < 0.0001) had the strongest relationships with pPTT. On multivariable analysis, only RV FAC, TAPSE, and RV-PA coupling were independent predictors of pPTT. We conclude that shortening of pPTT in patients with PAH results from altered RV-PA coupling, probably occurring as a result of reduced pulmonary arterial compliance. Thus, pPTT allows noninvasive determination of the status of both the pulmonary vasculature and the response of the RV in patients with PAH, thereby allowing monitoring of disease progression and regression.Keywords: pulse wave velocity, right ventricular-pulmonary artery coupling, echocardiography. Pulmonary arterial hypertension (PAH) is a lethal disease, characterized by pathological pulmonary vascular remodeling, that leads to elevated pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR), decreased pulmonary arterial compliance, and eventual right ventricular failure and death.1,2 Growing evidence suggests that pulmonary arterial compliance plays a critical role in the pathogenesis of PAH and right ventricular failure. 3 Decreased pulmonary arterial compliance causes premature reflection of waves from the distal pulmonary vasculature, leading to increased pulsatile right ventricular afterload and altered right ventricular-pulmonary artery (RV-PA) coupling. 3-5 Both loss of pulmonary arterial compliance and impaired RV-PA coupling are clinically important, because they are associated with increased mortality in patients with pulmonary hypertension. 6-11Pulse wave velocity, defined as the velocity of pressure waves traveling through the arterial system, correlates inversely with arterial compliance in the systemic circulation.12 With decreasing compliance, pulse wave velocity increases, and the time taken by the pressure wave to travel between...

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Section: Right Ventricular Function and Rv-pa Couplingmentioning

confidence: 99%

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

et al. 2016

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“…RV‐PA coupling was assessed by a ratio of RV end‐systolic elastance (Ees)/arterial elastance (Ea) that was estimated by “volume” method (Ees/Ea=RV stroke volume/end systolic volume) 17, 18. Although the volume method underestimates Ees/Ea, it strongly correlates to Ees/Ea and appears to be a better predictor of PAH outcome 18, 19. Ees was estimated as RV end systolic pressure/end systolic volume, and Ea was estimated as RV end systolic pressure/stroke volume 17, 18, 19, 20, 21.…”

Section: Methodsmentioning

confidence: 99%

“…Although the volume method underestimates Ees/Ea, it strongly correlates to Ees/Ea and appears to be a better predictor of PAH outcome 18, 19. Ees was estimated as RV end systolic pressure/end systolic volume, and Ea was estimated as RV end systolic pressure/stroke volume 17, 18, 19, 20, 21. One patient completed only phase‐contrast portion of CMR and did not complete cine CMR because of claustrophobia.…”

Section: Methodsmentioning

confidence: 99%

Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function

Gupta

Sharifov

Lloyd

et al. 2018

JAHA

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BackgroundPulmonary artery (PA) stiffness is associated with increased pulmonary vascular resistance (PVR). PA stiffness is accurately described by invasive PA impedance because it considers pulsatile blood flow through elastic PAs. We hypothesized that PA stiffness and impedance could be evaluated noninvasively by PA velocity transfer function (VTF), calculated as a ratio of the frequency spectra of output/input mean velocity profiles in PAs.Methods and ResultsIn 20 participants (55±19 years, 14 women) undergoing clinically indicated right‐sided heart catheterization, comprehensive phase‐contrast and cine‐cardiac magnetic resonance imaging was performed to calculate PA VTF, along with right ventricular mass and function. PA impedance was measured as a ratio of frequency spectra of invasive PA pressure and echocardiographically derived PA flow waveforms. Mean PA pressure was 29.5±13.6 mm Hg, and PVR was 3.5±2.8 Wood units. A mixed‐effects model showed VTF was significantly associated with PA impedance independent of elevation in pulmonary capillary wedge pressure (P=0.005). The mean of higher frequency moduli of VTF correlated with PVR (ρ=0.63; P=0.003) and discriminated subjects with low (n=10) versus elevated PVR (≥2.5 Wood units, n=10), with an area under the curve of 0.95, similar to discrimination by impedance (area under the curve=0.93). VTF had a strong inverse association with right ventricular ejection fraction (ρ=−0.73; P<0.001) and a significant positive correlation with right ventricular mass index (ρ=0.51; P=0.02).Conclusions VTF, a novel right ventricular–PA axis coupling parameter, is a surrogate for PA impedance with the potential to assess PA stiffness and elevation in PVR noninvasively and reliably using cardiac magnetic resonance imaging.

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“…2,3 Essa estrutura tem função de acomodar todo o sistema venoso de retorno ao coração, sendo, portanto, vulnerável a qualquer aumento agudo de estresse na parede. 4 A ressonância magnética cardíaca (RMC) tem ganhado importância na visualização e avaliação do VD por permitir explorar a sua anatomia e função de forma não invasiva, tridimensional e livre de limitações relacionadas ao tórax do paciente, além de dispensar exposição radioativa. Apresenta, também, excelente caracterização do tecido cardíaco e precisão ao quantificar volumes ventriculares e regurgitação valvar, além de permitir a análise de estruturas vasculares adjacentes (veias e artérias pulmonares), consolidando esse método de imagem em relação a outros exames.…”

Section: Introductionunclassified

Cardiovascular Magnetic Resonance Imaging in the Evaluation of the Right Ventricle and its Pathologies

Gonçalves¹,

Souto²,

Sousa³

et al. 2016

Arquivos Brasileiros De Cardiologia - Imagem Cardiovascular

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ResumoA ressonância magnética cardíaca (RMC) constitui método não invasivo e tridimensional que permite a avaliação morfológica e funcional de todas as câmaras do coração. Esse método tem ganhado importância na identificação e caracterização de cardiopatias primárias que envolvem o ventrículo direito (VD), além de doenças secundárias que levam à disfunção das câmaras direitas. Dessa forma, este trabalho objetiva elucidar a melhor metodologia no diagnóstico dessas doenças mediante a RMC. IntroduçãoNo coração normal, o ventrículo direito (VD) localiza-se mais anteriormente em relação ao esquerdo, posteriormente ao esterno, e delimitado pelos anéis das valvas tricúspide e pela via de saída, a qual se comunica com as artérias pulmonares.1 Diferentemente do ventrículo esquerdo (VE), que apresenta uma morfologia simétrica e elipsoidal, a forma do VD é complexa, apresentando-se triangular quando vista de perfil e com formato em crescente em corte transversal. 2,3Essa estrutura tem função de acomodar todo o sistema venoso de retorno ao coração, sendo, portanto, vulnerável a qualquer aumento agudo de estresse na parede. 4A ressonância magnética cardíaca (RMC) tem ganhado importância na visualização e avaliação do VD por permitir explorar a sua anatomia e função de forma não invasiva, tridimensional e livre de limitações relacionadas ao tórax do paciente, além de dispensar exposição radioativa. Apresenta, também, excelente caracterização do tecido cardíaco e precisão ao quantificar volumes ventriculares e regurgitação valvar, além de permitir a análise de estruturas vasculares adjacentes (veias e artérias pulmonares), consolidando esse método de imagem em relação a outros exames. [5][6][7] O entendimento do processo de remodelamento do VD é importante para uma melhor compreensão da resposta dessa câmara a aumentos de pressão e volume e, assim, correlacionar essas alterações com sintomas apresentados pelo paciente, obtendo-se um melhor delineamento diagnóstico e terapêutico.8 Dessa forma, na análise de VD devem-se ter em mente as doenças que possam levar a alterações secundárias nessa cavidade, assim como cardiopatias primárias que envolvam as câmaras direitas (Tabela 1).O objetivo deste trabalho é descrever a metodologia mais adequada para melhor elucidação diagnóstica em pacientes com comprometimento ventricular direito, assim como expor as doenças primárias e secundárias mais comuns que podem acometer o VD, e os achados da RMC em cada uma delas. Protocolos da RMCPara avaliação morfológica e funcional de VD devem ser inicialmente realizadas sequências de cinerressonância (Cine-RM) com steady state free precession (SSFP), em cortes predeterminados (4 câmaras eixo curto com cobertura de toda a cavidade, além de corte longitudinal de VD, ou de sua via de saída, que incluem infundíbulo e via de saída de VD). Essas são a recomendações básicas para qualquer exame, segundo protocolo das diretrizes da Sociedade Americana de Ressonância Cardíaca (SCMR). 9A partir dessas sequências devem-se identificar, no momento da aquisição, an...

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Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study

Abstract: Right ventriculo-arterial coupling in pulmonary hypertension can be studied with standard RHC and CMR. Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.

Cited by 263 publications

References 40 publications

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function

Cardiovascular Magnetic Resonance Imaging in the Evaluation of the Right Ventricle and its Pathologies

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