Stressing the right ventricular-pulmonary vascular unit: beyond pulmonary vascular resistance

Claessen, Guido; Gerche, André La

doi:10.1136/heartjnl-2016-310360

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Over the last years, several studies have described the prognostic value of PVR estimated by CMR in the assessment of HF with suspected PH [26,27]. However, in HF patients, PA compliance and stiffness are altered in early disease stages, before significant rise in PVR occurs [10][11][12][13][14]. Reduced PA compliance and PA stiffness result in inefficient RV-PA coupling [7][8][9] and have emerged as strong, early prognostic predictors in this setting [18,19,28].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, increasing evidence supporting a comprehensive evaluation of the right ventricular-pulmonary artery (RV-PA) unit that integrates RV function and its adaptation to loading conditions is emerging [8,9]. Importantly, RV-PA coupling not only encompasses the static component of RV afterload, expressed by pulmonary vascular resistance (PVR) [10,11], but also its pulsatile element, which is altered at earlier disease stages in HF [12][13][14]. Accordingly, inefficient RV-PA coupling can be detected promptly and acts as a reliable prognostic indicator [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction

Trejo-Velasco

Fabregat-Andrés²,

García-González

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Background Pulmonary hypertension (PH) conveys a worse prognosis in heart failure (HF), in particular when right ventricular (RV) dysfunction ensues. Cardiovascular magnetic resonance (CMR) non-invasively estimates pulmonary vascular resistance (PVR), which has shown prognostic value in HF. Importantly, RV to pulmonary artery (PA) coupling is altered early in HF, before significant rise in PV resistance occurs. The aim of this study was to assess the prognostic value of mean velocity at the pulmonary artery (mvPA), a novel non-invasive parameter determined by CMR, in HF with reduced ejection fraction (HFrEF) with and without associated PH. Methods Prospective inclusion of 238 patients admitted for new-onset HFrEF. MvPA was measured with CMR during index admission. The primary endpoint was defined as a composite of HF readmissions and all-cause mortality. Results During a median follow-up of 25 months, 91 patients presented with the primary endpoint. Optimal cut-off value of mvPA calculated by the receiver operator curve for the prediction of the primary endpoint was 9 cm/s. The primary endpoint occurred more frequently in patients with mvPA≤9 cm/s, as indicated by Kaplan-Meier survival curves; Log Rank 16.0, p < 0.001. Importantly, mvPA maintained its prognostic value regardless of RV function and also when considering mortality and HF readmissions separately. On Cox proportional hazard analysis, reduced mvPA≤9 cm/s emerged as an independent prognostic marker, together with NYHA III-IV/IV class, stage 3–4 renal failure and ischemic cardiomyopathy. Conclusions In our HFrEF cohort, mvPA emerged as an independent prognostic indicator independent of RV function, allowing identification of a higher-risk population before structural damage onset. Moreover, mvPA emerged as a surrogate marker of the RV-PA unit coupling status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction

Trejo-Velasco

Fabregat-Andrés²,

García-González

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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“…Claessen and La Gerche3 put these findings in perspective with a concise summary of normal and abnormal exercise hemodynamics. Figure 3 They comment: ‘Interestingly, it was found that coupling efficiency between the RV and the pulmonary circulation at rest was associated with maximum exercise tolerance whereas conventional metrics obtained by right heart catheterisation, such as pulmonary vascular resistance or cardiac output, were not.…”

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confidence: 99%

Heartbeat:Blood urea nitrogen to creatinine ratio predicts outcome in acute heart failure

Otto

2017

Heart

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Intravenous sildenafil acutely improves hemodynamic response to exercise in patients with connective tissue disease

Rieth¹,

Richter²,

Berkowitsch³

et al. 2018

PLoS ONE

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BackgroundHemodynamic assessment during exercise may unmask an impaired functional reserve of the right ventricle and the pulmonary vasculature in patients with connective tissue disease. We assessed the effect of intravenous sildenafil on the hemodynamic response to exercise in patients with connective tissue disease.MethodsIn this proof-of-concept study, patients with connective tissue disease and mean pulmonary arterial pressure (mPAP) >20 mm Hg were subjected to a supine exercise hemodynamic evaluation before and after administration of intravenous sildenafil 10 mg.ResultsTen patients (four with moderately elevated mPAP 21–24 mm Hg; six with mPAP >25 mm Hg) underwent hemodynamic assessment. All of them showed markedly abnormal exercise hemodynamics. Intravenous sildenafil was well tolerated and had significant hemodynamic effects at rest and during exercise, although without pulmonary selectivity. Sildenafil reduced median total pulmonary resistance during exercise from 6.22 (IQR 4.61–8.54) to 5.24 (3.95–6.96) mm Hg·min·L-1 (p = 0.005) and increased median pulmonary arterial capacitance during exercise from 1.59 (0.93–2.28) to 1.74 (1.12–2.69) mL/mm Hg (p = 0.005).ConclusionsIn patients with connective tissue disease who have an abnormal hemodynamic response to exercise, intravenous sildenafil improved adaption of the right ventricular-pulmonary vascular unit to exercise independent of resting mPAP. The impact of acute pharmacological interventions on exercise hemodynamics in patients with pulmonary vascular disease warrants further investigation.Trial registrationClinicaltrials.gov NCT01889966.

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Stressing the right ventricular-pulmonary vascular unit: beyond pulmonary vascular resistance

Cited by 3 publications

References 8 publications

Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction

Prognostic value of mean velocity at the pulmonary artery estimated by cardiovascular magnetic resonance as a prognostic predictor in a cohort of patients with new-onset heart failure with reduced ejection fraction

Heartbeat:Blood urea nitrogen to creatinine ratio predicts outcome in acute heart failure

Intravenous sildenafil acutely improves hemodynamic response to exercise in patients with connective tissue disease

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