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06.04.2024 | Congenital Heart Disease (RA Krasuski and G Fleming, Section Editors)

Right Ventricle-Pulmonary Artery Coupling in Patients Undergoing Cardiac Interventions

verfasst von: Crosby Culp, Jon Andrews, Katherine Wang Sun, Kendall Hunter, Anne Cherry, Mihai Podgoreanu, Alina Nicoara

Erschienen in: Current Cardiology Reports | Ausgabe 6/2024

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Abstract

Purpose of Review

This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac surgery, cardiac interventions, and congenital heart disease.

Recent Findings

The need for more accessible clinical means of evaluation of RV-PA coupling has driven researchers to investigate surrogates using cardiac MRI, echocardiography, and right-sided pressure measurements in patients undergoing cardiac surgery/interventions, as well as patients with congenital heart disease. Recent research has aimed to validate these alternative means against the gold standard, as well as establish cut-off values predictive of morbidity and/or mortality. This emerging evidence lays the groundwork for identifying appropriate RV-PA coupling surrogates and integrating them into perioperative clinical practice.
Literatur
8.
Zurück zum Zitat Frank O. Die wirkung von digitalis (helleborein) auf das herz. 1898. Frank O. Die wirkung von digitalis (helleborein) auf das herz. 1898.
14.
Zurück zum Zitat Abel FL, Waldhausen JA. Effects of alterations in pulmonary vascular resistance on right ventricular function. J Thorac Cardiovasc Surg. 1967;54(6):886–94.CrossRefPubMed Abel FL, Waldhausen JA. Effects of alterations in pulmonary vascular resistance on right ventricular function. J Thorac Cardiovasc Surg. 1967;54(6):886–94.CrossRefPubMed
19.
Zurück zum Zitat Sagawa K. Cardiac contraction and the pressure-volume relationship. Oxford University Press; 1988. Sagawa K. Cardiac contraction and the pressure-volume relationship. Oxford University Press; 1988.
21.
Zurück zum Zitat • Brener MI, Masoumi A, Ng VG, et al. Invasive right ventricular pressure-volume analysis: basic principles, clinical applications, and practical recommendations. Circ Heart Fail. 2022;15(1):e009101;15(1):e009101. https://doi.org/10.1161/circheartfailure.121.009101. This article serves as an excellent review of conductance catheter structure and function. There is also a review of pressure-volume loop measurement, analysis, and limitations.CrossRefPubMed • Brener MI, Masoumi A, Ng VG, et al. Invasive right ventricular pressure-volume analysis: basic principles, clinical applications, and practical recommendations. Circ Heart Fail. 2022;15(1):e009101;15(1):e009101. https://​doi.​org/​10.​1161/​circheartfailure​.​121.​009101. This article serves as an excellent review of conductance catheter structure and function. There is also a review of pressure-volume loop measurement, analysis, and limitations.CrossRefPubMed
47.
Zurück zum Zitat Muraru D, Spadotto V, Cecchetto A, et al. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging. 2016;17(11):1279–89. https://doi.org/10.1093/ehjci/jev309.CrossRefPubMed Muraru D, Spadotto V, Cecchetto A, et al. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging. 2016;17(11):1279–89. https://​doi.​org/​10.​1093/​ehjci/​jev309.CrossRefPubMed
55.
64.
Zurück zum Zitat • Cahill TJ, Pibarot P, Yu X, et al. Impact of right ventricle-pulmonary artery coupling on clinical outcomes in the PARTNER 3 trial. JACC Cardiovasc Interv. 2022;15(18):1823–1833;15(18):1823–33. https://doi.org/10.1016/j.jcin.2022.07.005. Investigators in this study used echocardiographic means of assessment of RV-PA coupling in patients with severe sortic stenosis randomized to surgical or transcatheter valve replacement, using TAPSE/PASP (PASP estimated using right-ventricular systolic pressure derived from a tricuspid regurgitation jet). A cut-off point of 0.55 was established, and prognostic significance was demonstarted as patients identified as having RV-PA uncoupling had a 2-fold increase in all-cause mortality, stroke, and rehospitalization at two years.CrossRefPubMed • Cahill TJ, Pibarot P, Yu X, et al. Impact of right ventricle-pulmonary artery coupling on clinical outcomes in the PARTNER 3 trial. JACC Cardiovasc Interv. 2022;15(18):1823–1833;15(18):1823–33. https://​doi.​org/​10.​1016/​j.​jcin.​2022.​07.​005. Investigators in this study used echocardiographic means of assessment of RV-PA coupling in patients with severe sortic stenosis randomized to surgical or transcatheter valve replacement, using TAPSE/PASP (PASP estimated using right-ventricular systolic pressure derived from a tricuspid regurgitation jet). A cut-off point of 0.55 was established, and prognostic significance was demonstarted as patients identified as having RV-PA uncoupling had a 2-fold increase in all-cause mortality, stroke, and rehospitalization at two years.CrossRefPubMed
76.
Zurück zum Zitat Hiremath GB, Callahan S, Thatte R, Rockefeller N, Nawaytou T, Redd H, Hussain SV, Brener T. MI. Clinical applications of pressure-volume assessment in congenital heart disease. J Soc Cardiovasc Angiogr Interv. 2023;2(3). Hiremath GB, Callahan S, Thatte R, Rockefeller N, Nawaytou T, Redd H, Hussain SV, Brener T. MI. Clinical applications of pressure-volume assessment in congenital heart disease. J Soc Cardiovasc Angiogr Interv. 2023;2(3).
83.
Zurück zum Zitat Vitarelli A, Miraldi F, Capotosto L, et al. Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices. Int J Cardiovasc Imaging. 2023;39(9):1631–41. https://doi.org/10.1007/s10554-023-02857-3.CrossRefPubMed Vitarelli A, Miraldi F, Capotosto L, et al. Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices. Int J Cardiovasc Imaging. 2023;39(9):1631–41. https://​doi.​org/​10.​1007/​s10554-023-02857-3.CrossRefPubMed
84.
Zurück zum Zitat Li M, Wang Y, Li H, et al. A prediction model of simple echocardiographic variables to screen for potentially correctable shunts in adult patients with pulmonary arterial hypertension associated with atrial septal defects: a cross-sectional study. Int J Cardiovasc Imaging. 2021;37(5):1551–62. https://doi.org/10.1007/s10554-020-02128-5.CrossRefPubMed Li M, Wang Y, Li H, et al. A prediction model of simple echocardiographic variables to screen for potentially correctable shunts in adult patients with pulmonary arterial hypertension associated with atrial septal defects: a cross-sectional study. Int J Cardiovasc Imaging. 2021;37(5):1551–62. https://​doi.​org/​10.​1007/​s10554-020-02128-5.CrossRefPubMed
89.
Zurück zum Zitat • Richter MJ, Yogeswaran A, Husain-Syed F, et al. A novel non-invasive and echocardiography-derived method for quantification of right ventricular pressure-volume loops. Eur Heart J Cardiovasc Imaging. 2022;23(4):498–507. https://doi.org/10.1093/ehjci/jeab038. This proof-of-concept study by Richter et al demonstrates methods to create pressure-volume loops using echocardiography alone, as well as with echocardiography and RV pressure monitoring.CrossRefPubMed • Richter MJ, Yogeswaran A, Husain-Syed F, et al. A novel non-invasive and echocardiography-derived method for quantification of right ventricular pressure-volume loops. Eur Heart J Cardiovasc Imaging. 2022;23(4):498–507. https://​doi.​org/​10.​1093/​ehjci/​jeab038. This proof-of-concept study by Richter et al demonstrates methods to create pressure-volume loops using echocardiography alone, as well as with echocardiography and RV pressure monitoring.CrossRefPubMed
95.
Zurück zum Zitat Butts RJ, Chowdhury SM, Buckley J, et al. Comparison of echocardiographic and pressure-volume loop indices of systolic function in patients with single ventricle physiology: a preliminary report. Congenit Heart Dis Jan-Feb. 2015;10(1):E17-24. https://doi.org/10.1111/chd.12191.CrossRef Butts RJ, Chowdhury SM, Buckley J, et al. Comparison of echocardiographic and pressure-volume loop indices of systolic function in patients with single ventricle physiology: a preliminary report. Congenit Heart Dis Jan-Feb. 2015;10(1):E17-24. https://​doi.​org/​10.​1111/​chd.​12191.CrossRef
Metadaten
Titel
Right Ventricle-Pulmonary Artery Coupling in Patients Undergoing Cardiac Interventions
verfasst von
Crosby Culp
Jon Andrews
Katherine Wang Sun
Kendall Hunter
Anne Cherry
Mihai Podgoreanu
Alina Nicoara
Publikationsdatum
06.04.2024
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 6/2024
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-024-02052-3

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