Open AccessRight ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation
Author(s) -
Egbe Alexander C.,
Miranda William R.,
Pellikka Patricia A.,
Pislaru Sorin V.,
Borlaug Barry A.,
Kothapalli Srikanth,
Ananthaneni Sindhura,
Sandhyavenu Harigopal,
Najam Maria,
Farouk Abdelsamid Mohamed,
Connolly Heidi M.
Publication year - 2019
Publication title -
congenital heart disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.828
H-Index - 42
eISSN - 1747-0803
pISSN - 1747-079X
DOI - 10.1111/chd.12768
Subject(s) - medicine , cardiology , pulmonic stenosis , tetralogy of fallot , pulmonary artery , cohort , pulmonary hypertension , pulmonary regurgitation , ventricular pressure , cardiac magnetic resonance imaging , stenosis , heart disease , magnetic resonance imaging , hemodynamics , radiology
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.