Dataset for: Ventriculo-Arterial Coupling Detects Occult RV Dysfunction in Chronic Thromboembolic Pulmonary Vascular Disease

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

Outcomes following PCI in CABG candidates during the COVID-19 pandemic: The prospective multicentre UK-ReVasc registry

Objectives:To describe outcomes following percutaneous coronary intervention (PCI)in patients who would usually have undergone coronary artery bypass grafting (CABG).Background:In the United Kingdom, cardiac surgery for coronary artery disease(CAD) was dramatically reduced during the first wave of the COVID-19 pandemic.Many patients with“surgical disease”instead underwent PCI.Methods:Between 1 March 2020 and 31 July 2020, 215 patients with recognized“surgical”CAD who underwent PCI were enrolled in the prospective UK-ReVascRegistry (ReVR). 30-day major cardiovascular event outcomes were collected. Find-ings in ReVR patients were directly compared to reference PCI and isolated CABGpre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) andNational Cardiac Audit Programme (NCAP) databases.Results:ReVR patients had higher incidence of diabetes (34.4% vs 26.4%,P=.008),multi-vessel disease with left main stem disease (51.4% vs 3.0%,P< .001) and leftanterior descending artery involvement (94.8% vs 67.2%,P< .001) compared to BCISdata. SYNTAX Score in ReVR was high (mean 28.0). Increased use of transradial access(93.3% vs 88.6%,P= .03), intracoronary imaging (43.6% vs 14.4%,P< .001) and cal-cium modification (23.6% vs 3.5%,P< .001) was observed. No difference in in-hospitalmortality was demonstrated compared to PCI and CABG data (ReVR 1.4% vs BCIS0.7%,P= .19; vs NCAP 1.0%,P= .48). Inpatient stay was half compared to CABG (3.0vs 6.0 days). Low-event rates in ReVR were maintained to 30-day follow-up.Conclusions:PCI undertaken using contemporary techniques produces excellentshort-term results in patients who would be otherwise CABG candidates. Longer-termfollow-up is essential to determine whether these outcomes are maintained over time.</p