Location of Repository

Ventriculo‐arterial coupling detects occult RV dysfunction in chronic thromboembolic pulmonary vascular disease

By Richard G. Axell, Simon J. Messer, Paul A. White, Colm McCabe, Andrew Priest, Thaleia Statopoulou, Maja Drozdzynska, Jamie Viscasillas, Elizabeth C. Hinchy, James Hampton‐Till, Hatim I. Alibhai, Nicholas Morrell, Joanna Pepke‐Zaba, Stephen R. Large and Stephen P. Hoole


Chronic thromboembolic disease (CTED) is suboptimally defined by a mean\ud pulmonary artery pressure (mPAP)\ud <\ud 25 mmHg at rest in patients that remain\ud symptomatic from chronic pulmonary artery thrombi. To improve identifica-\ud tion of right ventricular (RV) pathology in patients with thromboembolic\ud obstruction, we hypothesized that the RV ventriculo-arterial (Ees/Ea) coupling\ud ratio at maximal stroke work (Ees/Ea\ud max sw\ud ) derived from an animal model of\ud pulmonary obstruction may be used to identify occult RV dysfunction (low\ud Ees/Ea) or residual RV energetic reserve (high Ees/Ea). Eighteen open chested\ud pigs had conductance catheter RV pressure-volume (PV)-loops recorded dur-\ud ing PA snare to determine Ees/Ea\ud max sw\ud . This was then applied to 10 patients\ud with chronic thromboembolic pulmonary hypertension (CTEPH) and ten\ud patients with CTED, also assessed by RV conductance catheter and cardiopul-\ud monary exercise testing. All patients were then restratified by Ees/Ea. The ani-\ud mal model determined an Ees/Ea\ud max sw\ud =\ud 0.68\ud �\ud 0.23 threshold, either side of\ud which cardiac output and RV stroke work fell. Two patients with CTED were\ud identified with an Ees/Ea well below 0.68 suggesting occult RV dysfunction\ud whilst three patients with CTEPH demonstrated Ees/Ea\ud ≥\ud 0.68 suggesting\ud residual RV energetic reserve. Ees/Ea\ud >\ud 0.68 and Ees/Ea\ud <\ud 0.68 subgroups\ud demonstrated constant RV stroke work but lower stroke volume (87.7\ud �\ud 22.1\ud vs. 60.1\ud �\ud 16.3 mL respectively,\ud P\ud =\ud 0.006) and higher end-systolic pressure\ud (36.7\ud �\ud 11.6 vs. 68.1\ud �\ud 16.7 mmHg respectively,\ud P\ud <\ud 0.001). Lower Ees/Ea in\ud CTED also correlated with reduced exercise ventilatory efficiency. Low Ees/Ea\ud aligns with features of RV maladaptation in CTED both at rest and on exer-\ud cise. Characterization of Ees/Ea in CTED may allow for better identification\ud of occult RV dysfunctio

Year: 2017
OAI identifier: oai:arro.anglia.ac.uk:702776
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://dx.doi.org/10.14814/phy... (external link)
  • http://arro.anglia.ac.uk/70277... (external link)
  • Suggested articles


    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.