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Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension.
- Source :
-
Journal of Heart & Lung Transplantation . Nov2023, Vol. 42 Issue 11, p1518-1528. 11p. - Publication Year :
- 2023
-
Abstract
- 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. NCT04663217 [Display omitted] [ABSTRACT FROM AUTHOR]
- Subjects :
- *PULMONARY hypertension
*CARDIAC catheterization
*PULMONARY arterial hypertension
Subjects
Details
- Language :
- English
- ISSN :
- 10532498
- Volume :
- 42
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- Journal of Heart & Lung Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 172978601
- Full Text :
- https://doi.org/10.1016/j.healun.2023.07.004