Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study
Objective: To assess right ventricular (RV) function and RV-pulmonary arterial (PA) coupling by three-dimensions echocardiography and investigate the ability of RV-PA coupling to predict adverse clinical outcomes in patients with precapillary pulmonary hypertension (PH).Methods: We retrospectively c...
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doaj-57f798cc6ddf4cc98ca7643db227eabe2021-07-02T04:50:40ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-07-01810.3389/fcvm.2021.690606690606Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic StudyYidan Li0Dichen Guo1Juanni Gong2Jianfeng Wang3Qiang Huang4Shu Yang5Xinyuan Zhang6Huimin Hu7Zhe Jiang8Yuanhua Yang9Xiuzhang Lu10Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Intervention, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Intervention, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaPhilips (China) Investment Co. Ltd., Beijing, ChinaDepartment of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaObjective: To assess right ventricular (RV) function and RV-pulmonary arterial (PA) coupling by three-dimensions echocardiography and investigate the ability of RV-PA coupling to predict adverse clinical outcomes in patients with precapillary pulmonary hypertension (PH).Methods: We retrospectively collected a longitudinal cohort of 203 consecutive precapillary PH patients. RV volume, RV ejection fraction (RVEF), and RV longitudinal strain (RVLS) were quantitatively determined offline by 3D echocardiography. RV-PA coupling parameters including the RVEF/PA systolic pressure (PASP) ratio, pulmonary arterial compliance (PAC), and total pulmonary resistance (TPR) were recorded.Results: Over a median follow-up period of 20.9 months (interquartile range, 0.1–67.4 months), 87 (42.9%) of 203 patients experienced adverse clinical outcomes. With increasing World Health Organization functional class (WHO-FC), significant trends were observed in increasing RV volume, decreasing RVEF, and worsening RVLS. RV arterial coupling (RVAC) and PAC were lower and TPR was higher for WHO-FC III+IV than WHO-FC I or II. The RVEF/PASP ratio showed a significant correlation with RVLS. RVAC had a stronger correlation with the RVEF/PASP ratio than other indices. Multivariate Cox proportional-hazard analysis identified a lower 3D RVEF and worse RVLS as strong predictors of adverse clinical events. RVAC, TPR, and PAC had varying degrees of predictive value, with optimal cutoff values of 0.74, 11.64, and 1.18, respectively.Conclusions: Precapillary-PH with RV-PA uncoupling as expressed by a RVEF/PASP ratio <0.44 was associated with adverse clinical outcomes. PAC decreased and TPR increased with increasing WHO-FC, with TPR showing better independent predictive value.https://www.frontiersin.org/articles/10.3389/fcvm.2021.690606/fullright ventricular-arterial couplingpulmonary hypertensionright ventricular dysfunctionthree-dimensional echocardiographyprognosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yidan Li Dichen Guo Juanni Gong Jianfeng Wang Qiang Huang Shu Yang Xinyuan Zhang Huimin Hu Zhe Jiang Yuanhua Yang Xiuzhang Lu |
spellingShingle |
Yidan Li Dichen Guo Juanni Gong Jianfeng Wang Qiang Huang Shu Yang Xinyuan Zhang Huimin Hu Zhe Jiang Yuanhua Yang Xiuzhang Lu Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study Frontiers in Cardiovascular Medicine right ventricular-arterial coupling pulmonary hypertension right ventricular dysfunction three-dimensional echocardiography prognosis |
author_facet |
Yidan Li Dichen Guo Juanni Gong Jianfeng Wang Qiang Huang Shu Yang Xinyuan Zhang Huimin Hu Zhe Jiang Yuanhua Yang Xiuzhang Lu |
author_sort |
Yidan Li |
title |
Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study |
title_short |
Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study |
title_full |
Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study |
title_fullStr |
Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study |
title_full_unstemmed |
Right Ventricular Function and Its Coupling With Pulmonary Circulation in Precapillary Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study |
title_sort |
right ventricular function and its coupling with pulmonary circulation in precapillary pulmonary hypertension: a three-dimensional echocardiographic study |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2021-07-01 |
description |
Objective: To assess right ventricular (RV) function and RV-pulmonary arterial (PA) coupling by three-dimensions echocardiography and investigate the ability of RV-PA coupling to predict adverse clinical outcomes in patients with precapillary pulmonary hypertension (PH).Methods: We retrospectively collected a longitudinal cohort of 203 consecutive precapillary PH patients. RV volume, RV ejection fraction (RVEF), and RV longitudinal strain (RVLS) were quantitatively determined offline by 3D echocardiography. RV-PA coupling parameters including the RVEF/PA systolic pressure (PASP) ratio, pulmonary arterial compliance (PAC), and total pulmonary resistance (TPR) were recorded.Results: Over a median follow-up period of 20.9 months (interquartile range, 0.1–67.4 months), 87 (42.9%) of 203 patients experienced adverse clinical outcomes. With increasing World Health Organization functional class (WHO-FC), significant trends were observed in increasing RV volume, decreasing RVEF, and worsening RVLS. RV arterial coupling (RVAC) and PAC were lower and TPR was higher for WHO-FC III+IV than WHO-FC I or II. The RVEF/PASP ratio showed a significant correlation with RVLS. RVAC had a stronger correlation with the RVEF/PASP ratio than other indices. Multivariate Cox proportional-hazard analysis identified a lower 3D RVEF and worse RVLS as strong predictors of adverse clinical events. RVAC, TPR, and PAC had varying degrees of predictive value, with optimal cutoff values of 0.74, 11.64, and 1.18, respectively.Conclusions: Precapillary-PH with RV-PA uncoupling as expressed by a RVEF/PASP ratio <0.44 was associated with adverse clinical outcomes. PAC decreased and TPR increased with increasing WHO-FC, with TPR showing better independent predictive value. |
topic |
right ventricular-arterial coupling pulmonary hypertension right ventricular dysfunction three-dimensional echocardiography prognosis |
url |
https://www.frontiersin.org/articles/10.3389/fcvm.2021.690606/full |
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