Right Ventricular Dysfunction and Pulmonary Vascular Elastance Coupling in Candidates for Advanced Heart Failure Therapies

Abstract

Purpose Acute and chronic right ventricular (RV) dysfunction are common complications experienced by patients with advanced heart failure, particularly after receiving mechanical circulatory support. An elevated right atrial pressure to pulmonary artery wedge pressure ratio (RAP:PAWP) or a reduced pulmonary artery (PA) pulsatility index (PAPI) may identify patients at risk of RV dysfunction. We examined the relationship of these markers to RV end-systolic elastance (Ees), effective PA elastance (Ea), and their coupling ratio (Ees:Ea). Methods We studied patients with advanced heart failure undergoing right heart catheterization to assess cardiac transplant candidacy. We analyzed hemodynamics offline, and calculated both RAP:PAWP and PAPI. We determined RV Ees using the single-beat method and calculated PA Ea from the ratio of PA pressure to stroke volume. We considered cases with either RAP:PAWP >0.63 or PAPI Results Of 165 patients (age = 57 (53-60) years), 42 (25%) met either criteria for RV dysfunction; 33 (20%) had an elevated RAP:PAWP, 24 (15%) had a reduced PAPI, and 15 (9%) had both markers. There were no systematic differences between patients with (n = 42) or without (n = 123) RV dysfunction in terms of age, body mass index, heart rate, or mean arterial pressure. Cardiac index was lower among patients with RV dysfunction (1.8 (1.6-2.0) vs. 2.0 (1.7-2.2) L/min/m2, p = 0.025), as was RV stroke work index (4.6 (3.6-6.0) vs. 8.6 (6.6-11.0) g•m/m2, p Conclusion In patients with systolic heart failure being evaluated for advanced therapies, proposed markers of RV dysfunction are modestly associated with load-independent systolic RV performance, but not RV-PA coupling.