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Evaluation of right ventriculoarterial coupling in pulmonary hypertension: a magnetic resonance study

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Inadequate right ventriculo-arterial coupling is an important determinant of heart failure in pulmonary hypertension, in turn the main determinant of outcome in this disease... Coupling can be quantified as the ratio of pulmonary artery effective elastance (Ea, an index of arterial load) to right ventricular maximal end-systolic elastance (Emax, an index of contractility)... To quantify right ventriculo-arterial coupling in pulmonary hypertension combining standard right heart catheterization and cardiac magnetic resonance (CMR), and to noninvasively estimate it with CMR alone... Right heart catheterization provided mean pulmonary artery pressure (mPAP) as a surrogate of right ventricular end-systolic pressure, pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance index (PVRI)... Ea was calculated as (mPAP-PCWP)/SVI; and Emax as PAP/ESVI... Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas Emax increased initially but tended to decrease subsequently (Figure, 1B)... Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating uncoupling) with more severe pulmonary hypertension (Figure, 1C)... According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax... Ea/Emax approximated noninvasively with CMR as ESVI/SVI equaled 0.75, 1.17, 2.28, and 3.51, for PVRI quartile groups (Q1 to Q4) respectively, showing excellent correlation with Ea/Emax derived from invasive measurements (r=0.93, p<0.001) and progressing similarly with disease severity (p<0.001)... Right ventriculo-arterial coupling in pulmonary hypertension can be studied combining standard right heart catheterization and CMR indices... In addition, it can be approximated with CMR alone in a completely noninvasive fashion... Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.

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Ea, Emax and Ea/Emax according to pulmonary hypertension severity
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Figure 1: Ea, Emax and Ea/Emax according to pulmonary hypertension severity

Mentions: Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas Emax increased initially but tended to decrease subsequently (Figure, 1B). Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating uncoupling) with more severe pulmonary hypertension (Figure, 1C). According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax. Emax was independently associated with right atrial pressure after adjustment for PVRI (β=-2.81, p<0.05). Ea/Emax approximated noninvasively with CMR as ESVI/SVI equaled 0.75, 1.17, 2.28, and 3.51, for PVRI quartile groups (Q1 to Q4) respectively, showing excellent correlation with Ea/Emax derived from invasive measurements (r=0.93, p<0.001) and progressing similarly with disease severity (p<0.001).


Evaluation of right ventriculoarterial coupling in pulmonary hypertension: a magnetic resonance study
Ea, Emax and Ea/Emax according to pulmonary hypertension severity
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106498&req=5

Figure 1: Ea, Emax and Ea/Emax according to pulmonary hypertension severity
Mentions: Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas Emax increased initially but tended to decrease subsequently (Figure, 1B). Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating uncoupling) with more severe pulmonary hypertension (Figure, 1C). According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax. Emax was independently associated with right atrial pressure after adjustment for PVRI (β=-2.81, p<0.05). Ea/Emax approximated noninvasively with CMR as ESVI/SVI equaled 0.75, 1.17, 2.28, and 3.51, for PVRI quartile groups (Q1 to Q4) respectively, showing excellent correlation with Ea/Emax derived from invasive measurements (r=0.93, p<0.001) and progressing similarly with disease severity (p<0.001).

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Inadequate right ventriculo-arterial coupling is an important determinant of heart failure in pulmonary hypertension, in turn the main determinant of outcome in this disease... Coupling can be quantified as the ratio of pulmonary artery effective elastance (Ea, an index of arterial load) to right ventricular maximal end-systolic elastance (Emax, an index of contractility)... To quantify right ventriculo-arterial coupling in pulmonary hypertension combining standard right heart catheterization and cardiac magnetic resonance (CMR), and to noninvasively estimate it with CMR alone... Right heart catheterization provided mean pulmonary artery pressure (mPAP) as a surrogate of right ventricular end-systolic pressure, pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance index (PVRI)... Ea was calculated as (mPAP-PCWP)/SVI; and Emax as PAP/ESVI... Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas Emax increased initially but tended to decrease subsequently (Figure, 1B)... Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating uncoupling) with more severe pulmonary hypertension (Figure, 1C)... According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax... Ea/Emax approximated noninvasively with CMR as ESVI/SVI equaled 0.75, 1.17, 2.28, and 3.51, for PVRI quartile groups (Q1 to Q4) respectively, showing excellent correlation with Ea/Emax derived from invasive measurements (r=0.93, p<0.001) and progressing similarly with disease severity (p<0.001)... Right ventriculo-arterial coupling in pulmonary hypertension can be studied combining standard right heart catheterization and CMR indices... In addition, it can be approximated with CMR alone in a completely noninvasive fashion... Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.

No MeSH data available.


Related in: MedlinePlus