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Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension

医学 心脏病学 内科学 心室 肺动脉高压 冲程容积 舒张期 血流动力学 血压 心率
作者
Zvonimir A. Rako,Athiththan Yogeswaran,Bálint Károly Lakatos,Alexandra Fábián,Selin Yıldız,B Rocha,István Vadász,Hossein Ardeschir Ghofrani,Werner Seeger,Henning Gall,Nils Kremer,Manuel J. Richter,Pascal Bauer,Ryan J. Tedford,Robert Naeije,Attila Kovács,Khodr Tello
出处
期刊:Journal of Heart and Lung Transplantation [Elsevier]
卷期号:42 (11): 1518-1528 被引量:2
标识
DOI:10.1016/j.healun.2023.07.004
摘要

The right ventricle has a complex contraction pattern of uncertain clinical relevance. We aimed to assess the relationship between right ventricular (RV) contraction pattern and RV-pulmonary arterial (PA) coupling defined by the gold-standard pressure-volume loop-derived ratio of end-systolic/arterial elastance (Ees/Ea).Prospectively enrolled patients with suspected or confirmed pulmonary hypertension underwent three-dimensional echocardiography, standard right heart catheterization, and RV conductance catheterization. RV-PA uncoupling was categorized as severe (Ees/Ea < 0.8), moderate (Ees/Ea 0.8-1.29), and none/mild (Ees/Ea ≥ 1.3). Clinical severity was determined from hemodynamics using a truncated version of the 2022 European Society of Cardiology/European Respiratory Society risk stratification scheme.Fifty-three patients were included, 23 with no/mild, 24 with moderate, and 6 with severe uncoupling. Longitudinal shortening was decreased in patients with moderate vs no/mild uncoupling (p <0.001) and intermediate vs low hemodynamic risk (p < 0.001), discriminating low risk from intermediate/high risk with an optimal threshold of 18% (sensitivity 80%, specificity 87%). Anteroposterior shortening was impaired in patients with severe vs moderate uncoupling (p = 0.033), low vs intermediate risk (p = 0.018), and high vs intermediate risk (p = 0.010), discriminating high risk from intermediate/low risk with an optimal threshold of 15% (sensitivity 100%, specificity 83%). Left ventricular (LV) end-diastolic volume was decreased in patients with severe uncoupling (p = 0.035 vs no/mild uncoupling).Early RV-PA uncoupling is associated with reduced longitudinal function, whereas advanced RV-PA uncoupling is associated with reduced anteroposterior movement and LV preload, all in a risk-related fashion.GOV: NCT04663217.
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