Journal article
Authors list: Rako, Zvonimir A.; Yogeswaran, Athiththan; Lakatos, Balint K.; Fabian, Alexandra; Yildiz, Selin; da Rocha, Bruno Brito; Vadasz, Istvan; Ghofrani, Hossein Ardeschir; Seeger, Werner; Gall, Henning; Kremer, Nils C.; Richter, Manuel J.; Bauer, Pascal; Tedford, Ryan J.; Naeije, Robert; Kovacs, Attila; Tello, Khodr
Publication year: 2023
Pages: 1518-1528
Journal: The Journal of Heart and Lung Transplantation
Volume number: 42
Issue number: 11
ISSN: 1053-2498
eISSN: 1557-3117
DOI Link: https://doi.org/10.1016/j.healun.2023.07.004
Publisher: Elsevier
Abstract:
Background: 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).Methods: 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.Results: 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).Conclusions: 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.
Citation Styles
Harvard Citation style: Rako, Z., Yogeswaran, A., Lakatos, B., Fabian, A., Yildiz, S., da Rocha, B., et al. (2023) Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension, The Journal of Heart and Lung Transplantation, 42(11), pp. 1518-1528. https://doi.org/10.1016/j.healun.2023.07.004
APA Citation style: Rako, Z., Yogeswaran, A., Lakatos, B., Fabian, A., Yildiz, S., da Rocha, B., Vadasz, I., Ghofrani, H., Seeger, W., Gall, H., Kremer, N., Richter, M., Bauer, P., Tedford, R., Naeije, R., Kovacs, A., & Tello, K. (2023). Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension. The Journal of Heart and Lung Transplantation. 42(11), 1518-1528. https://doi.org/10.1016/j.healun.2023.07.004
Keywords
ECHOCARDIOGRAPHY; preserved ejection; pulmonary arterial; three-dimensional
