Right ventricular and pulmonary vascular function indices for risk stratification of patients with pulmonary regurgitation

• Published in: Congenital heart disease Vol. 14; no. 4; p. 657
• Main Authors: Egbe, Alexander C, Miranda, William R, Pellikka, Patricia A, Pislaru, Sorin V, Borlaug, Barry A, Kothapalli, Srikanth, Ananthaneni, Sindhura, Sandhyavenu, Harigopal, Najam, Maria, Farouk Abdelsamid, Mohamed, Connolly, Heidi M
• Format: Journal Article
• Language: English
• Published: United States 01.07.2019
• Subjects: Adult; Echocardiography; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Magnetic Resonance Imaging, Cine - methods; Male; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Pulmonary Valve Insufficiency - diagnosis; Pulmonary Valve Insufficiency - physiopathology; Retrospective Studies; Risk Assessment; Stroke Volume; Vascular Resistance - physiology; Ventricular Function, Right - physiology; exercise capacity; pulmonary regurgitation; tetralogy of Fallot; right ventricular to pulmonary arterial coupling; pulmonic stenosis
• ISSN: 1747-0803
• DOI: 10.1111/chd.12768

We hypothesized that echocardiographic indices of right ventricular to pulmonary artery (RV-PA) coupling were comparable to cardiac magnetic resonance imaging (CMRI)-derived RV volumetric indices in predicting disease severity in chronic pulmonary regurgitation (PR). Patients with ≥ moderate PR (2003-2015) with and without prior CMRI scans were enrolled into the study cohort and validation cohort, respectively. Endpoint was to determine the association between noninvasive RV-PA coupling indices (tricuspid annular plane systolic excursion/right ventricular systolic pressure [TAPSE/RVSP] and fractional area change [FAC]/RVSP ratio) and markers of disease severity, and compared this association to that of CMRI-derived RV volumetric indices and markers of disease severity (peak oxygen consumption [VO ], NT-proBNP and atrial and/or ventricular arrhythmias). Of the 256 patients in the study cohort (age 33 ± 6 years), 187 (73%) had tetralogy of Fallot (TOF) while 69 (27%) had valvular pulmonic stenosis (VPS). TAPSE/RVSP (r = 0.73, P < .001) and FAC/RVSP (r = 0.78, P < .001) correlated with peak VO . Among the CMRI-derived RV volumetric indices analyzed, only right ventricular end-systolic volume index correlated with peak VO (r = -0.54, P < .001) and NT-proBNP (r = 0.51, P < .001). These RV-PA coupling indices were tested in the validation cohort of 218 patients (age 37 ± 9 years). Similar to the study cohort, TAPSE/RVSP (r = 0.59, P < .001) and FAC/RVSP (r = 0.70, P < .001) correlated with peak VO . TAPSE/RVSP (but not FAC/RVSP) was also associated with arrhythmia occurrence in both the study cohort and validation cohorts. Noninvasive RV-PA coupling may provide complementary prognostic data in the management of chronic PR. Further studies are required to explore this clinical tool.