Evaluation of right ventriculoarterial coupling in pulmonary hypertension: a magnetic resonance study
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Evaluation of right ventriculoarterial coupling in pulmonary hypertension: a magnetic resonance study Javier Sanz*, Ana Garcia-Alvarez Msc, Leticia Fernandez-Friera, Ajith Nair, Jesus G Mirelis, Simonette Sawit, Sean Pinney, Valentin Fuster From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Introduction Inadequate right ventriculo-arterial coupling is an important determinant of heart failure in pulmonary hypertension, in turn the main determinant of outcome in this disease. Coupling can be quantified as the ratio of pulmonary artery effective elastance (Ea, an index of arterial load) to right ventricular maximal end-systolic elastance (Emax, an index of contractility). Objective To quantify right ventriculo-arterial coupling in pulmonary hypertension combining standard right heart catheterization and cardiac magnetic resonance (CMR), and to noninvasively estimate it with CMR alone. Methods We included 139 patients undergoing CMR and right heart catheterization within 2 days (n=151 test pairs) for
the evaluation of known or suspected pulmonary hypertension. Right ventricular end-systolic volume index (ESVI) and stroke volume index (SVI) were obtained, respectively, from cardiac cine images and phasecontrast of the pulmonary artery after adjusting for body surface area. Right heart catheterization provided mean pulmonary artery pressure (mPAP) as a surrogate of right ventricular end-systolic pressure, pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance index (PVRI). Ea was calculated as (mPAPPCWP)/SVI; and Emax as PAP/ESVI.
Results Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas E max increased initially but tended to decrease subsequently (Figure, 1B). Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating
Figure 1 Ea, Emax and Ea/Emax according to pulmonary hypertension severity.
Mount Sinai School of Medicine, New York, NY, USA © 2011 Sanz et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sanz et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O73 http://jcmr-online.com/content/13/S1/O73
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uncoupling) with more severe pulmonary hypertension (Figure, 1C). According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax. Emax was independently associated with right atrial pressure after adjustment for PVRI (b=-2.81, p
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