Ventricle-pulmonary Artery Coupling Research Articles

Association between Right Ventricle-Pulmonary Artery Coupling with In-Hospital Outcome after Triple Valve Surgery in Rheumatic Heart Disease.

Triple valve surgery (TVS) is a relatively higher in-hospital mortality rate than any isolated valve surgery. In advanced-stage valvular heart disease, maladaptation may occur, creating RV-PA uncoupling. Aims To evaluate whether RV-PA coupling is associated with the in-hospital outcome of patients after TVS. From the medical records, clinical and echocardiography data were collected and compared between the survived and patients with in-hospital mortality groups. Patients with the rheumatic multivalvular disease who underwent triple valve surgery were included in the study. Statistical and analysis used Uni and bivariate analysis assessed any association between the RV-PA coupling using TAPSE/PASP and other clinical variables with the in-hospital mortality post TVS. From 269 patients, the in-hospital mortality rate was 10 %. The median value of TAPSE/PASP ratio in all group is 0.41 (0.02-5.79). Impaired RV-PA coupling which value < 0.36 occurs in 38.3 % population. By multivariate analysis, independent predictors of in-hospital mortality were TAPSE/PASP < 0.36 (OR 3.46, 95 % CI 1.21 - 9.89; P 0.02), age (OR 1.04, 95 % CI 1.003-1.094; P 0.035), CPB duration, (OR 1.01, 95 % CI 1.003-1.017; P 0.005). RV-PA uncoupling assessed by TAPSE / PASP ratio < 0.36 is associated with the in-hospital mortality in patients post triple valve surgery. Other factors associated with the outcome were older age and longer CPB machine duration.

TCT-42 Impact of Right Ventricle-Pulmonary Artery Coupling on Clinical Outcomes After Transcatheter and Surgical Aortic Valve Replacement: An Analysis of the PARTNER 3 Trial

TCT-42 Impact of Right Ventricle-Pulmonary Artery Coupling on Clinical Outcomes After Transcatheter and Surgical Aortic Valve Replacement: An Analysis of the PARTNER 3 Trial

Defining end-systolic pressure for single-beat estimation of right ventricle-pulmonary artery coupling: simple… but not really.

Surrogates of right ventricle (RV) end-systolic pressure (ESP) used to determine RV–pulmonary artery coupling vary across studies. ESP using point of maximal time varying elastance provides most accurate estimate of actual ESP. https://bit.ly/3xuqX3B

Increased Pulmonary Arterial Stiffness and Impaired Right Ventricle-Pulmonary Artery Coupling In PCOS.

ResumoFundamento:A síndrome dos ovários policísticos (SOP) é a doença endócrino-metabólica mais comum em mulheres em idade reprodutiva, e ocorre em uma a cada 10 mulheres. A doença inclui irregularidade menstrual e excesso de hormônios masculinos e é a causa mais comum de infertilidade em mulheres. A dispneia é um sintoma frequente e muitas vezes acredita-se que seja decorrente da obesidade, mas não se sabe se é decorrente de disfunção cardíaca.Objetivo:Avaliar o acoplamento ventrículo-arterial (VDAP) e a rigidez arterial pulmonar em pacientes com SOP.Métodos:Foram incluídos 44 pacientes com SOP e 60 controles; amostras de sangue venoso foram coletadas para exames laboratoriais e ecocardiograma transtorácico 2-D, Modo-M e com Doppler tecidual foram realizados em todos os participantes. Um valor de p<0,05 foi considerado estatisticamente significativo.Resultados:Quando comparadas ao grupo controle, as pacientes com SOP apresentaram valores maiores de rigidez da artéria pulmonar (p = 0,001), que se correlacionaram positivamente com o índice HOMA-IR (r = 0,545 e p <0,001). O acoplamento VDAP também estava comprometido em 34% dos pacientes do estudo.Conclusão:A rigidez da artéria pulmonar está aumentada e o acoplamento VDAP está comprometido em pacientes com SOP. (Arq Bras Cardiol. 2021; 116(4):806-811)

New measures of right ventricle-pulmonary artery coupling in heart failure: An all-cause mortality echocardiographic study

AimsRight ventricle-pulmonary artery coupling (RVPAC) has emerged from pathophysiology to clinical interest for prognostic implication in heart failure and is commonly measured as the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/SPAP). However, feasibility of SPAP is limited (down to 60% in trials, and maybe lower in clinical practice). We ought to assess the prognostic value of the TAPSE times pulmonary acceleration time (TAPSE x pACT) product and TAPSE to peak tricuspid regurgitation velocity (TAPSE/TRV) ratio as new alternative measures of RVPAC. Methods and resultsTwo-hundred patients hospitalized with heart failure were followed-up (median time of 2.7 years) and 82 died. Non survivors had significantly lower TAPSE/SPAP, TAPSE x pACT and TAPSE/TRV than survivors (0.31 vs 0.40 mm/mmHg, 130 vs 156 cm·ms, 5.0 vs 5.8 ms, respectively). Four multivariate models were performed, each one including TAPSE, TAPSE/SPAP, TAPSE x pACT or TAPSE/TRV. TAPSE/SPAP resulted the most powerful predictor of mortality (HR 0.74 per mm/mmHg increase, P < 0.001, C-Statistic 0.778), followed by TAPSE x pACT (HR 0.95 per 10 cm·ms increase, P = 0.013, C-Statistic 0.776), TAPSE/TRV (HR 0.76 per ms increase, P < 0.001, C-Statistic 0.774) and TAPSE (HR 0.91 per mm increase, P = 0.003, C-Statistic 0.769). Cutoff values of 140 cm·ms and 5.5 ms were respectively identified for TAPSE x pACT and TAPSE/TRV with receiving operating characteristic analysis for mortality. ConclusionTAPSE x pACT product and TAPSE/TRV ratio are alternative measures of RVPAC for prognostic assessment in heart failure that can be applied if TAPSE/SPAP is not feasible.

Cardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing

Cardiopulmonary exercise testing (CPET) represents the gold standard to estimate peak oxygen consumption (VO2) noninvasively. To improve the analysis of the mechanisms behind effort intolerance, we examined whether exercise stress echocardiography measurements relate to directly measured peak VO2 during exercise in a large cohort of patients within the heart failure (HF) spectrum. We performed a symptom-limited graded ramp bicycle CPET exercise stress echocardiography in 30 healthy controls and 357 patients: 113 at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 244 in HF stage C with preserved (HFpEF, n=101) or reduced ejection fraction (HFrEF, n=143). Peak VO2 significantly decreased from controls (23, 21.7-29.7mL/kg/minute; median, interquartile range) to stage A-B (18, 15.4-20.7mL/kg/minute) and stage C (HFpEF: 13.6, 11.8-16.8mL/kg/minute; HFrEF: 14.2, 10.7-17.5mL/kg/minute). A regression model to predict peak VO2 revealed that peak left ventricular (LV) systolic annulus tissue velocity (S'), peak tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (right ventricle-pulmonary artery coupling), and low-load left atrial (LA) reservoir strain/E/e' (LA compliance) were independent predictors, in addition to peak heart rate, stroke volume, and workload (adjusted R2=0.76, P<.0001). The model was successfully tested in subjects with atrial fibrillation (n=49) and with (n=224) and without (n=163) beta-blockers (all P<.01). Peak S' showed the highest accuracy in predicting peak VO2<10mL/kg/minute (cut point≤7.5cm/sec, area under the curve=0.92, P<.0001) and peak VO2>20mL/kg/minute (cut point>12.5cm/sec, area under the curve=0.84, P<.0001) in comparison with the other cardiac variables of the model (P<.05). Peak VO2 is directly related to measures of LV systolic function, LA compliance, and right ventricle-pulmonary artery coupling, in addition to heart rate and stroke volume and independently of workload, age, and sex. The evaluation of cardiac mechanics may provide more insights into the causes of effort intolerance in subjects from HF stages A-C.

Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement

BackgroundTo evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling.MethodRV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients.ResultsNinety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P = < 0.05, r = 0.35), RVESVi (P = < 0.001, r = 0.41) and negatively correlated with RVSVi (P = < 0.05, r = 0.22) and RVEF (P = < 0.05, r = 0.78).ConclusionsUnfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

Simple Echocardiographic Parameters to Capture Acute Changes in Right Ventricle-Pulmonary Artery Coupling in a Large Animal Model of Pulmonary Hypertension

Simple Echocardiographic Parameters to Capture Acute Changes in Right Ventricle-Pulmonary Artery Coupling in a Large Animal Model of Pulmonary Hypertension

Non-invasive Right Ventricle-pulmonary Artery Coupling Predicts Events in Pulmonary Arterial Hypertension and in Left Heart Disease

Non-invasive Right Ventricle-pulmonary Artery Coupling Predicts Events in Pulmonary Arterial Hypertension and in Left Heart Disease

Experts consensus on the management of the right heart function in critically ill patients

Experts consensus on the management of the right heart function in critically ill patients

Diagnosing and treating the failing right heart.

Right ventricular failure (RVF) is associated with significant morbidity and mortality. There is an increasing interest in proper assessment of right ventricle (RV) function as well as understanding mechanisms behind RVF. Within this article, we discuss the metabolic changes that occur in the RV in response to RVF, in particular, a shift toward glycolysis and increased glutaminolysis. We will detail the advances made in noninvasive imaging in assessing the function of the RV and review the methods to assess right ventricle-pulmonary artery coupling. We lastly investigate the role of new treatment options in the failing RV, such as β-blocker therapy. RVF is a complicated entity. Although some inferences on RV function and treatment can be made from our understanding of the left ventricle, the RV has unique features, anatomically, metabolically and embryologically, that require dedicated RV-directed research.

Mechanics and Mechanisms of Pulmonary Hypertension — Conference Summary and Translational Perspectives

The imagination has made more discoveries than the eye To catch an imagination of the future of pulmonary hypertension was exactly the spirit of the 55th ASPEN lung Conference. Basic scientists, pre-clinicians, clinicians and pharma joined together to achieve one goal—to combine creativity and inventiveness in a battle against a deadly disease. Summarizing this conference on “Mechanics and Mechanisms of Pulmonary Hypertension” is challenging in several aspects: To extract key novel findings from 12 state-of-the-art lectures, 25 oral presentations, 56 posters along with the integration of own data on discussed topics, to include hundreds of important questions, answers and discussion raised during the conference, to provide the line of thinking for the next 5–10 years of pulmonary hypertension (PH) research development and to focus equally well on both basic and translational research. Kurt Stenmark and Todd Bull, who chaired the conference, intensified this challenge several-fold by selecting a plethora of topics ranging from development of cardiopulmonary systems to pathogenesis of right ventricular failure, mechanics of right ventricle-pulmonary artery coupling to genomics and from understanding metabolic aspects to developing therapies for PH. With that, need not say, but a special admiration and thanks to the conference chairs for assembling such outstanding state-of-the-art speakers, for clustering the presentations logically and for leading lively and engaging discussions. Although it may look fragmentary, we would like to divide the conference summary into four major conceptual realms: The pulmonary vasculature in PH; right heart in PH; individualized approach- personalized medicine; and beyond PH-vascular abnormalities in COPD. - Joseph Joubert