Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension
Abstract Background The 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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14180 |
| _version_ | 1797824621298319360 |
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| author | Sara Louise Hungerford Katherine Kearney Ning Song Nicole Bart Eugene Kotlyar Edmund Lau Andrew Jabbour Christopher Simon Hayward David William Marshall Muller Audrey Adji |
| author_facet | Sara Louise Hungerford Katherine Kearney Ning Song Nicole Bart Eugene Kotlyar Edmund Lau Andrew Jabbour Christopher Simon Hayward David William Marshall Muller Audrey Adji |
| author_sort | Sara Louise Hungerford |
| collection | DOAJ |
| description | Abstract Background The 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. Methods Prospective 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). Results Baseline 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 <25 mmHg: 47 ± 19 dynes.s.cm−5; PrecPH 86 ± 20 dynes.s.cm−5; IpcPH 66 ± 30 dynes.s.cm−5; CpcPH 86 ± 39 dynes.s.cm−5; 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. Conclusions Raised 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. |
| first_indexed | 2024-03-13T10:41:42Z |
| format | Article |
| id | doaj.art-14fc30e3453846ea84d17fee0235f005 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T10:41:42Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-14fc30e3453846ea84d17fee0235f0052023-05-18T03:08:57ZengWileyESC Heart Failure2055-58222023-06-011031811182110.1002/ehf2.14180Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertensionSara Louise Hungerford0Katherine Kearney1Ning Song2Nicole Bart3Eugene Kotlyar4Edmund Lau5Andrew Jabbour6Christopher Simon Hayward7David William Marshall Muller8Audrey Adji9Department of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Respiratory Medicine Royal Prince Alfred Hospital Sydney AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaDepartment of Cardiology St Vincent's Hospital Darlinghurst AustraliaAbstract Background The 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. Methods Prospective 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). Results Baseline 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 <25 mmHg: 47 ± 19 dynes.s.cm−5; PrecPH 86 ± 20 dynes.s.cm−5; IpcPH 66 ± 30 dynes.s.cm−5; CpcPH 86 ± 39 dynes.s.cm−5; 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. Conclusions Raised 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.https://doi.org/10.1002/ehf2.14180Cardiac magnetic resonance imagingPulmonary arterial impedanceRight heart catheterizationRight ventricular–pulmonary arterial coupling |
| spellingShingle | Sara Louise Hungerford Katherine Kearney Ning Song Nicole Bart Eugene Kotlyar Edmund Lau Andrew Jabbour Christopher Simon Hayward David William Marshall Muller Audrey Adji Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension ESC Heart Failure Cardiac magnetic resonance imaging Pulmonary arterial impedance Right heart catheterization Right ventricular–pulmonary arterial coupling |
| title | Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| title_full | Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| title_fullStr | Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| title_full_unstemmed | Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| title_short | Prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| title_sort | prognostic role of pulmonary impedance estimation to predict right ventricular dysfunction in pulmonary hypertension |
| topic | Cardiac magnetic resonance imaging Pulmonary arterial impedance Right heart catheterization Right ventricular–pulmonary arterial coupling |
| url | https://doi.org/10.1002/ehf2.14180 |
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