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

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2 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 [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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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

Egbe, A., Miranda, W. R., Pellikka, P., 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. https://doi.org/10.1111/chd.12768