TY - JOUR
T1 - Ventricular-vascular coupling is predictive of adverse clinical outcome in paediatric pulmonary arterial hypertension
AU - Dufva, Melanie J.
AU - Ivy, Dunbar
AU - Campbell, Kristen
AU - Lam, Aimee
AU - Rauff, Adam
AU - Breeman, Karel T. N.
AU - Douwes, Johannes M.
AU - Berger, Rolf M. F.
AU - Kheyfets, Vitaly Oleg
AU - Hunter, Kendall
N1 - Funding Information: Funding This work was supported by NIH/NCATS Colorado CTSA Grant Number UL1 TR002535, NIH K25 HL133481, and the Jayden de Luca foundation. JMD was supported by the Royal Netherlands Academy of Arts and Sciences,Ter Meulen Fund; KTNB and JMD were supported by the Sebald Fund. The University of Colorado has received research support from Actelion Pharmaceuticals Ltd, Bayer, Eli Lilly & Co, Janssen and United Therapeutics for DDI to perform clinical trials; the University of Colorado contracts with Actelion Pharmaceuticals Ltd, Bayer HealthCare, Eli Lilly & Co and United Therapeutics for DD Ivy to be a consultant. The University Medical Centrum Groningen contracts with Actelion Pharmaceuticals, Lilly and Pfizer for advisory board and steering committee activities of RMFB. Publisher Copyright: © 2021 Institute of Electrical and Electronics Engineers Inc.. All rights reserved.
PY - 2021/9/28
Y1 - 2021/9/28
N2 - Aims Ventricular-vascular coupling, the ratio between the right ventricle's contractile state (E es) and its afterload (E a), may be a useful metric in the management of paediatric pulmonary arterial hypertension (PAH). In this study we assess the prognostic capacity of the ventricular-vascular coupling ratio (E es /E a) derived using right ventricular (RV) pressure alone in children with PAH. Methods One hundred and thirty paediatric patients who were diagnosed with PAH via right heart catheterisation were retrospectively reviewed over a 10-year period. Maximum RV isovolumic pressure and end-systolic pressure were estimated using two single-beat methods from Takeuchi et al (E es /E a (Takeuchi)) and from Kind et al (E es /E a (Kind)) and used with an estimate of end-systolic pressure to compute ventricular-vascular coupling from pressure alone. Patients were identified as either idiopathic/hereditary PAH or associated PAH (IPAH/HPAH and APAH, respectively). Haemodynamic data, clinical functional class and clinical worsening outcomes - separated into soft (mild) and hard (severe) event categories - were assessed. Adverse soft events included functional class worsening, syncopal event, hospitalisation due to a proportional hazard-related event and haemoptysis. Hard events included death, transplantation, initiation of prostanoid therapy and hospitalisation for atrial septostomy and Pott's shunt. Cox proportional hazard modelling was used to assess whether E es /E a was predictive of time-to-event. Results In patients with IPAH/HPAH, E es /E a (Kind) and E es /E a (Takeuchi) were both independently associated with time to hard event (p=0.003 and p=0.001, respectively) and when adjusted for indexed pulmonary vascular resistance (p=0.032 and p=0.013, respectively). Neither E es /E a (Kind) nor E es /E a (Takeuchi) were associated with time to soft event. In patients with APAH, neither E es /E a (Kind) nor E es /E a (Takeuchi) were associated with time to hard event or soft event. Conclusions E es /E a derived from pressure alone is a strong independent predictor of adverse outcome and could be a potential powerful prognostic tool for paediatric PAH.
AB - Aims Ventricular-vascular coupling, the ratio between the right ventricle's contractile state (E es) and its afterload (E a), may be a useful metric in the management of paediatric pulmonary arterial hypertension (PAH). In this study we assess the prognostic capacity of the ventricular-vascular coupling ratio (E es /E a) derived using right ventricular (RV) pressure alone in children with PAH. Methods One hundred and thirty paediatric patients who were diagnosed with PAH via right heart catheterisation were retrospectively reviewed over a 10-year period. Maximum RV isovolumic pressure and end-systolic pressure were estimated using two single-beat methods from Takeuchi et al (E es /E a (Takeuchi)) and from Kind et al (E es /E a (Kind)) and used with an estimate of end-systolic pressure to compute ventricular-vascular coupling from pressure alone. Patients were identified as either idiopathic/hereditary PAH or associated PAH (IPAH/HPAH and APAH, respectively). Haemodynamic data, clinical functional class and clinical worsening outcomes - separated into soft (mild) and hard (severe) event categories - were assessed. Adverse soft events included functional class worsening, syncopal event, hospitalisation due to a proportional hazard-related event and haemoptysis. Hard events included death, transplantation, initiation of prostanoid therapy and hospitalisation for atrial septostomy and Pott's shunt. Cox proportional hazard modelling was used to assess whether E es /E a was predictive of time-to-event. Results In patients with IPAH/HPAH, E es /E a (Kind) and E es /E a (Takeuchi) were both independently associated with time to hard event (p=0.003 and p=0.001, respectively) and when adjusted for indexed pulmonary vascular resistance (p=0.032 and p=0.013, respectively). Neither E es /E a (Kind) nor E es /E a (Takeuchi) were associated with time to soft event. In patients with APAH, neither E es /E a (Kind) nor E es /E a (Takeuchi) were associated with time to hard event or soft event. Conclusions E es /E a derived from pressure alone is a strong independent predictor of adverse outcome and could be a potential powerful prognostic tool for paediatric PAH.
KW - healthcare
KW - hypertension
KW - outcome assessment
KW - pulmonary
KW - pulmonary arterial hypertension
UR - http://www.scopus.com/inward/record.url?scp=85116327662&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/openhrt-2021-001611
DO - https://doi.org/10.1136/openhrt-2021-001611
M3 - Article
C2 - 34583983
SN - 2398-595X
VL - 8
JO - Open Heart
JF - Open Heart
IS - 2
M1 - e001611
ER -