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Assessment of right ventricular function in advanced heart failure with nonischemic dilated cardiomyopathy: insights of right ventricular elastance.
- Source :
-
Journal of cardiovascular medicine (Hagerstown, Md.) [J Cardiovasc Med (Hagerstown)] 2020 Feb; Vol. 21 (2), pp. 134-143. - Publication Year :
- 2020
-
Abstract
- Background: The right ventriculoarterial coupling (R-V/A), a measure of right ventricular systolic dysfunction (RVSD) adaptation/maladaptation to chronic overload, and consequent pulmonary hypertension, has been little investigated in nonischemic dilated cardiomyopathy (NIDCM). We examined the correlates of R-V/A and traditional echocardiographic indices of RVSD, over the spectrum of pulmonary hypertension and tertiles of mean pulmonary artery pressures (PAPm).<br />Methods: In 2016-2017, we studied 81 consecutive patients for heart transplant/advanced heart failure. Inclusion criteria were NIDCM, reduced ejection fraction (≤40%) and sinus rhythm. R-V/A was computed as the RV/pulmonary elastances ratio (R-Elv/P-Ea), derived from a combined right heart catheterization/transthoracic- echocardiographic assessment [right heart catheterization/transthoracic-echocardiographic (RHC/TTE)].<br />Results: A total of 68 patients (mean age 64 ± 7 years, 82% men) were eligible. After adjustments, R-Elv and P-Ea were higher in isolated postcapillary-pulmonary hypertension (Ipc-PH) than combined-pulmonary hypertension (Cpc-PH) (P = 0.004 and P = 0.002, respectively), whereas R-V/A progressively decreased over Ipc-PH and Cpc-PH (P = 0.006). According to PAPm increment, P-Ea congruently increased (P-Trend = 0.028), R-Elv progressively decreased (P-Trend<0.00)1, whereas R-V/A significantly worsened (P-Trend = 0.045). At the multivariable analysis, a reduced RV longitudinal function (TAPSE<17 mm) was positively associated with R-V/A impairment (<0.8) [odds ratio 1.41, 95% confidence interval (CI) (1.07--1.87), P = 0.015]. R-Elv and P-Ea showed good interobserver reliability [interclass correlation (ICC) 0.84, 95% CI (0.32--0.99), P = 0.012 and ICC 0.98, 95% CI (0.93--99), P < 0.001, respectively].<br />Conclusion: Among NIDCM HF patients, in a small cohort study, RHC/TTE-derived R-V/A assessment demonstrated good correlations with pulmonary hypertension types and RV functional status. These data suggest that R-V/A encloses comprehensive information of the whole cardiopulmonary efficiency, better clarifying the amount of RVSD, with good reliability.
- Subjects :
- Aged
Cardiomyopathy, Dilated physiopathology
Cardiomyopathy, Dilated therapy
Cross-Sectional Studies
Female
Heart Failure physiopathology
Heart Failure therapy
Humans
Hypertension, Pulmonary physiopathology
Hypertension, Pulmonary therapy
Male
Middle Aged
Predictive Value of Tests
Prognosis
Pulmonary Artery physiopathology
Reproducibility of Results
Retrospective Studies
Stroke Volume
Ventricular Dysfunction, Right physiopathology
Ventricular Dysfunction, Right therapy
Arterial Pressure
Cardiomyopathy, Dilated diagnostic imaging
Echocardiography, Doppler
Heart Failure diagnostic imaging
Hypertension, Pulmonary diagnostic imaging
Pulmonary Artery diagnostic imaging
Ventricular Dysfunction, Right diagnostic imaging
Ventricular Function, Right
Subjects
Details
- Language :
- English
- ISSN :
- 1558-2035
- Volume :
- 21
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular medicine (Hagerstown, Md.)
- Publication Type :
- Academic Journal
- Accession number :
- 31923053
- Full Text :
- https://doi.org/10.2459/JCM.0000000000000921