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

Alexander Egbe, William R. Miranda, Patricia 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

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 [VO 2 ], 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 VO 2 . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO 2 (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 VO 2 . 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)
JournalCongenital Heart Disease
DOIs
StatePublished - Jan 1 2019

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Pulmonary Valve Insufficiency
Ventricular Pressure
Pulmonary Artery
Blood Vessels
Cohort Studies
Magnetic Resonance Imaging
Blood Pressure
Lung
Validation Studies
Cardiac Arrhythmias
Pulmonary Valve Stenosis
Tetralogy of Fallot
Oxygen Consumption
Stroke Volume
pro-brain natriuretic peptide (1-76)

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

Cite this

Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation. / Egbe, Alexander; Miranda, William R.; Pellikka, Patricia; Pislaru, Sorin V.; Borlaug, Barry A; Kothapalli, Srikanth; Ananthaneni, Sindhura; Sandhyavenu, Harigopal; Najam, Maria; Farouk Abdelsamid, Mohamed; Connolly, Heidi M.

In: Congenital Heart Disease, 01.01.2019.

Research output: Contribution to journalArticle

Egbe, Alexander ; Miranda, William R. ; Pellikka, Patricia ; Pislaru, Sorin V. ; Borlaug, Barry A ; Kothapalli, Srikanth ; Ananthaneni, Sindhura ; Sandhyavenu, Harigopal ; Najam, Maria ; Farouk Abdelsamid, Mohamed ; Connolly, Heidi M. / Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation. In: Congenital Heart Disease. 2019.
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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 [VO 2 ], 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 VO 2 . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO 2 (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 VO 2 . 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.",
keywords = "exercise capacity, pulmonary regurgitation, pulmonic stenosis, right ventricular to pulmonary arterial coupling, tetralogy of Fallot",
author = "Alexander Egbe and Miranda, {William R.} and Patricia Pellikka and Pislaru, {Sorin V.} and Borlaug, {Barry A} and Srikanth Kothapalli and Sindhura Ananthaneni and Harigopal Sandhyavenu and Maria Najam and {Farouk Abdelsamid}, Mohamed and Connolly, {Heidi M.}",
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AU - Egbe, Alexander

AU - Miranda, William R.

AU - Pellikka, Patricia

AU - Pislaru, Sorin V.

AU - Borlaug, Barry A

AU - Kothapalli, Srikanth

AU - Ananthaneni, Sindhura

AU - Sandhyavenu, Harigopal

AU - Najam, Maria

AU - Farouk Abdelsamid, Mohamed

AU - Connolly, Heidi M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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 [VO 2 ], 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 VO 2 . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO 2 (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 VO 2 . 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.

AB - 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 [VO 2 ], 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 VO 2 . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO 2 (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 VO 2 . 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.

KW - exercise capacity

KW - pulmonary regurgitation

KW - pulmonic stenosis

KW - right ventricular to pulmonary arterial coupling

KW - tetralogy of Fallot

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