Hungerford, Sara Louise and Kearney, Katherine and Li, Christina and Song, Ning and Everett, Kay and Gulati, Gaurav and Olsen, Nicholas and Lau, Edmund and Jabbour, Andrew and Bart, Nicole and Kotlyar, Eugene and Muller, David and Hayward, Christopher and Kapur, Navin and Adji, Audrey (2024) Pulsatile Vascular Afterload Measurement Improves Prediction of Right‐Sided Heart Dysfunction in Undifferentiated and Left‐Sided Pulmonary Hypertension. Journal of the American Heart Association, 13 (23). pp. e034684. ISSN 2047-9980
Full text not available from this repository.Abstract
Background
The association between raised pulmonary artery pressures, pulmonary vascular resistance (PVR), and right‐sided heart dysfunction is well recognized. The added value of pulsatile indices, specifically pulmonary arterial compliance (PAC) and characteristic impedance, remains unclear. This study aimed to identify the optimal vascular afterload model for predicting right‐sided heart dysfunction in newly diagnosed pulmonary hypertension (PH).
METHODS AND RESULTS
This was a prospective cohort study of 86 patients with suspected PH (60±16 years; 66 women) who underwent right‐sided heart catheterization and cardiac magnetic resonance imaging. Right ventricular end‐diastolic volume index (RVEDVi) and right atrial (RA) volume index were measured using cardiac magnetic resonance imaging. Vascular resistance, PAC, and characteristic impedance were measured using pulmonary artery pressure from right‐sided heart catheterization and pulmonary artery flow from cardiac magnetic resonance imaging. Optimal model fit was determined by the lowest Akaike Information Criterion value. A total of 58% of patients had a right ventricular ejection fraction <50%, 63% had an increased RVEDVi, and 56% had an increased RA volume index. Overall, PVR was the best predictor of right ventricular ejection fraction <50% ( P <0.01), increased RVEDVi ( P <0.01), and RA volume index ( P =0.02). However, for patients with a PVR <240 dynes.s.cm −5 , PAC clinical outperformed PVR in predicting right ventricular ejection fraction <50% ( P =0.02) and increased RVEDVi ( P =0.05). A 3‐component model (PVR, PAC clinical , and characteristic impedance) best predicted RA dilatation ( P =0.05). In paired analysis, alternative methods of PAC quantification better predicted increased RVEDVi (PAC decay P =0.02) and RA volume index (PAC area P =0.02). PAC clinical <2.3 mL/mm Hg optimally predicted right‐sided heart dysfunction (area under the curve, 0.768) and increased the AUC for PVR in undifferentiated/left‐sided PH (0.89 versus 0.72).
Conclusions
Pulsatile vascular afterload measurement improves right‐sided heart dysfunction prediction in undifferentiated/left‐sided PH. More accurate PAC measurement methods could further enhance prognostic accuracy, while a PVR ≥240 dynes.s.cm −5 remains a valuable threshold for precapillary PH.
| Item Type: | Article |
|---|---|
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 05 May 2025 00:14 |
| Last Modified: | 05 May 2025 00:14 |
| URI: | https://eprints.victorchang.edu.au/id/eprint/1645 |
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