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      Evaluation of right ventriculoarterial coupling in pulmonary hypertension: a magnetic resonance study

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      1 , , 1 , 1 , 1 , 1 , 1 , 1 , 1
      Journal of Cardiovascular Magnetic Resonance
      BioMed Central
      2011 SCMR/Euro CMR Joint Scientific Sessions
      3-6 February 2011

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          Abstract

          Introduction Inadequate right ventriculo-arterial coupling is an important determinant of heart failure in pulmonary hypertension, in turn the main determinant of outcome in this disease. Coupling can be quantified as the ratio of pulmonary artery effective elastance (Ea, an index of arterial load) to right ventricular maximal end-systolic elastance (Emax, an index of contractility). Objective To quantify right ventriculo-arterial coupling in pulmonary hypertension combining standard right heart catheterization and cardiac magnetic resonance (CMR), and to noninvasively estimate it with CMR alone. Methods We included 139 patients undergoing CMR and right heart catheterization within 2 days (n=151 test pairs) for the evaluation of known or suspected pulmonary hypertension. Right ventricular end-systolic volume index (ESVI) and stroke volume index (SVI) were obtained, respectively, from cardiac cine images and phase-contrast of the pulmonary artery after adjusting for body surface area. Right heart catheterization provided mean pulmonary artery 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)/SVI; and Emax as PAP/ESVI. Results Ea increased linearly with advancing severity (as determined by PVRI quartiles; Figure, 1A), whereas Emax increased initially but tended to decrease subsequently (Figure, 1B). Thus, the ratio Ea/Emax was maintained in earlier stages but increased markedly (indicating uncoupling) with more severe pulmonary hypertension (Figure, 1C). According to underlying etiologies and after adjustment for age, gender and PVRI, there were no significant differences amongst World Health Organization groups in terms of Ea/Emax. Emax was independently associated with right atrial pressure after adjustment for PVRI (β=-2.81, p<0.05). Ea/Emax approximated noninvasively with CMR as ESVI/SVI equaled 0.75, 1.17, 2.28, and 3.51, for PVRI quartile groups (Q1 to Q4) respectively, showing excellent correlation with Ea/Emax derived from invasive measurements (r=0.93, p<0.001) and progressing similarly with disease severity (p<0.001). Figure 1 Ea, Emax and Ea/Emax according to pulmonary hypertension severity Conclusions Right ventriculo-arterial coupling in pulmonary hypertension can be studied combining standard right heart catheterization and CMR indices. In addition, it can be approximated with CMR alone in a completely noninvasive fashion. Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.

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          Author and article information

          Conference
          J Cardiovasc Magn Reson
          Journal of Cardiovascular Magnetic Resonance
          BioMed Central
          1097-6647
          1532-429X
          2011
          2 February 2011
          : 13
          : Suppl 1
          : O73
          Affiliations
          [1 ]Mount Sinai School of Medicine, New York, NY, USA
          Article
          1532-429X-13-S1-O73
          10.1186/1532-429X-13-S1-O73
          3106498
          d10e1f25-9feb-47b4-99c5-7e5fea9cb887
          Copyright ©2011 Sanz et al; licensee BioMed Central Ltd.

          This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          2011 SCMR/Euro CMR Joint Scientific Sessions
          Nice, France
          3-6 February 2011
          History
          Categories
          Oral Presentation

          Cardiovascular Medicine
          Cardiovascular Medicine

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