Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation

Alexander C. Egbe, William R. Miranda, Patricia A. Pellikka, Sorin V. Pislaru, Barry A. Borlaug, Srikanth Kothapalli, Sindhura Ananthaneni, Harigopal Sandhyavenu, Maria Najam, Mohamed Farouk Abdelsamid, Heidi M. Connolly

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background: We hypothesized that echocardiographic indices of right ventricular to pulmonary artery (RV-PA) coupling were comparable to cardiac magnetic resonance imaging (CMRI)-derived RV volumetric indices in predicting disease severity in chronic pulmonary regurgitation (PR). Methods: Patients with ≥ moderate PR (2003-2015) with and without prior CMRI scans were enrolled into the study cohort and validation cohort, respectively. Endpoint was to determine the association between noninvasive RV-PA coupling indices (tricuspid annular plane systolic excursion/right ventricular systolic pressure [TAPSE/RVSP] and fractional area change [FAC]/RVSP ratio) and markers of disease severity, and compared this association to that of CMRI-derived RV volumetric indices and markers of disease severity (peak oxygen consumption [VO2], NT-proBNP and atrial and/or ventricular arrhythmias). Results: Of the 256 patients in the study cohort (age 33 ± 6 years), 187 (73%) had tetralogy of Fallot (TOF) while 69 (27%) had valvular pulmonic stenosis (VPS). TAPSE/RVSP (r = 0.73, P <.001) and FAC/RVSP (r = 0.78, P <.001) correlated with peak VO2. Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO2 (r = −0.54, P <.001) and NT-proBNP (r = 0.51, P <.001). These RV-PA coupling indices were tested in the validation cohort of 218 patients (age 37 ± 9 years). Similar to the study cohort, TAPSE/RVSP (r = 0.59, P <.001) and FAC/RVSP (r = 0.70, P <.001) correlated with peak VO2. TAPSE/RVSP (but not FAC/RVSP) was also associated with arrhythmia occurrence in both the study cohort and validation cohorts. Conclusion: Noninvasive RV-PA coupling may provide complementary prognostic data in the management of chronic PR. Further studies are required to explore this clinical tool.

Original languageEnglish (US)
Pages (from-to)657-664
Number of pages8
JournalCongenital Heart Disease
Volume14
Issue number4
DOIs
StatePublished - 2019

Keywords

  • exercise capacity
  • pulmonary regurgitation
  • pulmonic stenosis
  • right ventricular to pulmonary arterial coupling
  • tetralogy of Fallot

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Egbe, A. C., Miranda, W. R., Pellikka, P. A., Pislaru, S. V., Borlaug, B. A., Kothapalli, S., Ananthaneni, S., Sandhyavenu, H., Najam, M., Farouk Abdelsamid, M., & Connolly, H. M. (2019). Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation. Congenital Heart Disease, 14(4), 657-664. https://doi.org/10.1111/chd.12768