OBJECTIVES: To quantify right ventriculo-arterial coupling in pulmonary hypertension by combining standard right heart catheterisation (RHC) and cardiac magnetic resonance (CMR) and to estimate it non-invasively with CMR alone.
METHODS: This was a cross-sectional analysis in a retrospective cohort of consecutive patients from a tertiary care centre. There were 139 adults referred for pulmonary hypertension evaluation. Interventions: CMR and RHC within 2 days (n=151 test pairs). The main outcome measures right ventriculo-arterial coupling was quantified as the ratio of pulmonary artery (PA) effective elastance (Ea, index of arterial load) to right ventricular maximal end-systolic elastance (Emax, index of contractility). Right ventricular end-systolic volume (ESV) and stroke volume (SV) were obtained from CMR and adjusted to body surface area. RHC provided mean PA 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 (mPAP − PCWP)/SV and Emax as mPAP/ESV.
RESULTS: Ea increased linearly with advancing severity as defined by PVRI quartiles (0.19, 0.50, 0.93 and 1.63 mmHg/ml/m2, respectively; p
CONCLUSIONS: Right ventriculo-arterial coupling in pulmonary hypertension can be studied with standard RHC and CMR. Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.
Cardiopulmonary Imaging, Section Head
Cleveland Clinic Florida
Latest posts by Jacobo Kirsch (see all)
- Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus - August 24, 2016
- Prognostic Value of Late Gadolinium Enhancement CMR in Systemic Amyloidosis - August 24, 2016
- State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes - August 15, 2016