Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation

Alexander Egbe, Srikanth Kothapalli, William R. Miranda, Sorin Pislaru, Naser M. Ammash, Barry A Borlaug, Patricia Pellikka, Maria Najam, Heidi M. Connolly

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. Methods: This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. Results: RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. Conclusions: There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.

Original languageEnglish (US)
Pages (from-to)914-922
Number of pages9
JournalCanadian Journal of Cardiology
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Pulmonary Valve Insufficiency
Blood Pressure
Lung
Tetralogy of Fallot
Pulmonary Valve Stenosis
Stroke Volume
Exercise
Right Ventricular Function
Control Groups
Ventricular Pressure
Oxygen Consumption
Retrospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation. / Egbe, Alexander; Kothapalli, Srikanth; Miranda, William R.; Pislaru, Sorin; Ammash, Naser M.; Borlaug, Barry A; Pellikka, Patricia; Najam, Maria; Connolly, Heidi M.

In: Canadian Journal of Cardiology, Vol. 35, No. 7, 01.07.2019, p. 914-922.

Research output: Contribution to journalArticle

Egbe, Alexander ; Kothapalli, Srikanth ; Miranda, William R. ; Pislaru, Sorin ; Ammash, Naser M. ; Borlaug, Barry A ; Pellikka, Patricia ; Najam, Maria ; Connolly, Heidi M. / Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation. In: Canadian Journal of Cardiology. 2019 ; Vol. 35, No. 7. pp. 914-922.
@article{92e3c523cbe84c5cbc1dd7a28455372f,
title = "Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation",
abstract = "Background: We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. Methods: This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50{\%}. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46{\%}). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. Results: RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6{\%} vs 41 ± 5{\%} [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. Conclusions: There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.",
author = "Alexander Egbe and Srikanth Kothapalli and Miranda, {William R.} and Sorin Pislaru and Ammash, {Naser M.} and Borlaug, {Barry A} and Patricia Pellikka and Maria Najam and Connolly, {Heidi M.}",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.cjca.2019.03.009",
language = "English (US)",
volume = "35",
pages = "914--922",
journal = "Canadian Journal of Cardiology",
issn = "0828-282X",
publisher = "Pulsus Group Inc.",
number = "7",

}

TY - JOUR

T1 - Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation

AU - Egbe, Alexander

AU - Kothapalli, Srikanth

AU - Miranda, William R.

AU - Pislaru, Sorin

AU - Ammash, Naser M.

AU - Borlaug, Barry A

AU - Pellikka, Patricia

AU - Najam, Maria

AU - Connolly, Heidi M.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. Methods: This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. Results: RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. Conclusions: There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.

AB - Background: We hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. Methods: This was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. Results: RV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. Conclusions: There is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.

UR - http://www.scopus.com/inward/record.url?scp=85068214177&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068214177&partnerID=8YFLogxK

U2 - 10.1016/j.cjca.2019.03.009

DO - 10.1016/j.cjca.2019.03.009

M3 - Article

VL - 35

SP - 914

EP - 922

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

SN - 0828-282X

IS - 7

ER -