Prognostic Significance of Hemodynamics in Patients With Transposition of the Great Arteries and Systemic Right Ventricle

• Published in: Circulation. Heart failure Vol. 17; no. 9; p. e011882
• Main Authors: Aldweib, Nael, Deghani, Payam, Broberg, Craig S, van Dissel, Alexandra, Altibi, Ahmad, Wong, Joshua, Baker, David, Gindi, Salil, Khairy, Paul, Opotowsky, Alexander R, Shah, Sangeeta, Magalski, Anthony, Cramer, Jonathan, Kauling, Robert M, Dellborg, Mikael, Krieger, Eric V, Yeung, Elizabeth, Roos-Hesselink, Jolien, Aboulhosn, Jamil, Nicolarsen, Jeremy, Masha, Luke, Gallego, Pastora, Celermajer, David S, Kay, Joseph, Vonder Muhll, Isabelle, Jameson, Susan M, O'Donnell, Clare, Fusco, Flavia, John, Anitha S, Macon, Conrad, Antonova, Petra, Cotts, Timothy, Sarubbi, Berardo, Rodriguez, 3rd, Fred, DeZorzi, Christopher, Jayadeva, Pavithra S, Kuo, Marissa, Kutty, Shelby, Gupta, Tripti, Burchill, Luke J, Rodriguez Monserrate, Carla P, Lubert, Adam M, Grewal, Jasmine, Pylypchuk, Stephen, Belkin, Mark N, Wilson, William M
• Format: Journal Article
• Language: English
• Published: United States 01.09.2024
• Subjects: Adult; arterial pressure; Cardiac Catheterization; cardiac output; Clinical Medicine; congenitally corrected transposition of the great arteries; Female; heart ventricles; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; hemodynamics; Hemodynamics - physiology; Humans; Klinisk medicin; Male; Middle Aged; Prognosis; pulmonary wedge pressure; Pulmonary Wedge Pressure - physiology; Retrospective Studies; stroke volume; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery; Ventricular Function, Right - physiology; cardiac output; congenitally corrected transposition of the great arteries; arterial pressure; cardiac catheterization; pulmonary wedge pressure; heart ventricles; hemodynamics; stroke volume
• ISSN: 1941-3289; 1941-3297; 1941-3297
• DOI: 10.1161/CIRCHEARTFAILURE.124.011882

Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle. This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support. Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5-15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01-11.62; <0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63-9.02; <0.001). A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.