RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension

Vanderpool, Rebecca; Pinsky, Michael R.; Naeije, Robert; Deible, Christopher; Kosaraju, Vijaya; Bunner, Cheryl; Mathier, Michael A.; Lacomis, Joan M.; Champion, Hunter C.; Simon, Marc A.

doi:10.1136/heartjnl-2014-306142

Cited by 293 publications

(299 citation statements)

References 20 publications

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…Increased RA and RV surface areas, an altered EI, estimates of RAP from diastolic function indices, the RV Tei index, and several other variables are surrogate markers of diastolic RV function provided by TTE. [135][136][137] Echocardiographic 3D assessment of ventricular volumes and calculated RVEF and LVEF has made significant progress over the past decade, although it does not reach the accuracy of the gold-standard cardiac MRI.…”

Section: D Echocardiographymentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

View full text Add to dashboard Cite

Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

show abstract

Section: D Echocardiographymentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

View full text Add to dashboard Cite

show abstract

“…[3][4][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][7][8][9][10][11] Pulse 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 2 vascular points (pulmonary pulse wave transit time [pPTT]) shortens.…”

mentioning

confidence: 99%

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

et al. 2016

View full text Add to dashboard Cite

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...

show abstract

“…Assessments of ventricular mass, volumes, and function were then obtained, as previously described 15, 16. 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.…”

Section: Methodsmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

Novel Noninvasive Assessment of Pulmonary Arterial Stiffness Using Velocity Transfer Function

Gupta

Sharifov

Lloyd

et al. 2018

JAHA

View full text Add to dashboard Cite

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.

show abstract

RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension

Cited by 293 publications

References 20 publications

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

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

Contact Info

Product

Resources

About