Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension

被引:8
作者
Hungerford, Sara Louise [1 ,2 ,3 ,4 ,7 ]
Kearney, Katherine [1 ,2 ,3 ]
Song, Ning [1 ,2 ,3 ]
Bart, Nicole [1 ,2 ,3 ]
Kotlyar, Eugene [1 ]
Lau, Edmund [5 ]
Jabbour, Andrew [1 ,2 ,3 ]
Hayward, Christopher Simon [1 ,2 ,3 ]
Muller, David William Marshall [1 ,2 ,3 ]
Adji, Audrey [1 ,2 ,3 ,6 ]
机构
[1] St Vincents Hosp, Dept Cardiol, Darlinghurst, Australia
[2] Univ New South Wales, Sydney, Australia
[3] Victor Chang Cardiac Res Inst, Sydney, Australia
[4] Royal North Shore Hosp, Dept Cardiol, Sydney, Australia
[5] Royal Prince Alfred Hosp, Dept Resp Med, Sydney, Australia
[6] Macquarie Univ, BPVF Dept, Med Sch, Sydney, Australia
[7] St Vincents Hosp, Cardiol Dept, Victoria St, Darlinghurst 2010, Australia
关键词
Cardiac magnetic resonance imaging; Pulmonary arterial impedance; Right heart catheterization; Right ventricular-pulmonary arterial coupling; ARTERIAL IMPEDANCE; HEART; STIFFNESS; FLOW; LOAD;
D O I
10.1002/ehf2.14180
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundThe effect of pulmonary hypertension (PH) on right ventricular (RV) afterload is commonly defined by elevation of pulmonary artery (PA) pressure or pulmonary vascular resistance (PVR). In humans however, one-third to half of the hydraulic power in the PA is contained in pulsatile components of flow. Pulmonary impedance (Zc) expresses opposition of the PA to pulsatile blood flow. We evaluate pulmonary Zc relationships according to PH classification using a cardiac magnetic resonance (CMR)/right heart catheterization (RHC) method. MethodsProspective study of 70 clinically indicated patients referred for same-day CMR and RHC [60 +/- 16 years; 77% females, 16 mPAP <25 mmHg (PVR <240 dynes.s.cm(-5)/mPCWP <15 mmHg), 24 pre-capillary (PrecPH), 15 isolated post-capillary (IpcPH), 15 combined pre-capillary/post-capillary (CpcPH)]. CMR provided assessment of PA flow, and RHC, central PA pressure. Pulmonary Zc was expressed as the relationship of PA pressure to flow in the frequency domain (dynes.s.cm(-5)). ResultsBaseline demographic characteristics were well matched. There was a significant difference in mPAP (P < 0.001), PVR (P = 0.001), and pulmonary Zc between mPAP<25 mmHg patients and those with PH (mPAP P = 0.05). For all patients with PH, elevated mPAP was found to be associated with raised PVR (P < 0.001) but not with pulmonary Zc (P = 0.87), except for those with PrecPH (P < 0.001). Elevated pulmonary Zc was associated with reduced RVSWI, RVEF, and CO (all P < 0.05), whereas PVR and mPAP were not. ConclusionsRaised pulmonary Zc was independent of elevated mPAP in patients with PH and more strongly predictive of maladaptive RV remodelling than PVR and mPAP. Use of this straightforward method to determine pulmonary Zc may help to better characterize pulsatile components of RV afterload in patients with PH than mPAP or PVR alone.
引用
收藏
页码:1811 / 1821
页数:11
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