Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension

BackgroundAn accurate assessment of intrinsic right ventricular (RV) contractility and its relation to pulmonary arterial load is essential for the management of pulmonary hypertension. The pressure‐volume relationship with load manipulation is the gold standard assessment used for this purpose, but...

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Autores principales:	Ryo Inuzuka, Steven Hsu, Ryan J. Tedford, Hideaki Senzaki
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	contractility heart failure pressure‐volume relationship pulmonary circulation pulmonary hypertension pulmonary impedance Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5dc9aab0c9524965972a46a68dbd8837
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spelling	oai:doaj.org-article:5dc9aab0c9524965972a46a68dbd88372021-11-12T17:02:06ZSingle‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension10.1161/JAHA.117.0079292047-9980https://doaj.org/article/5dc9aab0c9524965972a46a68dbd88372018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.117.007929https://doaj.org/toc/2047-9980BackgroundAn accurate assessment of intrinsic right ventricular (RV) contractility and its relation to pulmonary arterial load is essential for the management of pulmonary hypertension. The pressure‐volume relationship with load manipulation is the gold standard assessment used for this purpose, but its clinical application has been hindered by the lack of a single‐beat method that is valid for the human RV. In the present study, we sought to validate a novel single‐beat method to estimate the preload recruitable stroke work (PRSW) and its derivative for ventriculoarterial coupling in the human RV. Methods and ResultsA novel single‐beat slope of the PRSW relationship (Msw) was derived by calculating the mean ejection pressure when the end‐systolic volume was equal to volume‐axis intercept of the PRSW relationship. In addition, by using a mathematical transformation of the equation representing the linearity of the PRSW relationship, a novel index for ventriculoarterial coupling, Msw/mean ejection pressure, was developed. RV pressure‐volume relationships were measured in 31 patients (including 23 patients with pulmonary hypertension) who were referred for right‐sided heart catheterization. In this cohort, the single‐beat Msw was strongly correlated with the multiple‐beat Msw (r=0.91, P<0.0001). Moreover, a significant correlation was observed between the single‐ and multiple‐beat Msw/mean ejection pressure (r=0.53, P=0.002), with a stronger correlation in those with greater RV systolic pressure (r=0.70, P=0.003). ConclusionsThe novel single‐beat approach provided an accurate estimation of indexes for the PRSW relationship and ventriculoarterial coupling. It may be particularly useful in assessing RV adaptation to increased pressure overload.Ryo InuzukaSteven HsuRyan J. TedfordHideaki SenzakiWileyarticlecontractilityheart failurepressure‐volume relationshippulmonary circulationpulmonary hypertensionpulmonary impedanceDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	contractility heart failure pressure‐volume relationship pulmonary circulation pulmonary hypertension pulmonary impedance Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	contractility heart failure pressure‐volume relationship pulmonary circulation pulmonary hypertension pulmonary impedance Diseases of the circulatory (Cardiovascular) system RC666-701 Ryo Inuzuka Steven Hsu Ryan J. Tedford Hideaki Senzaki Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
description	BackgroundAn accurate assessment of intrinsic right ventricular (RV) contractility and its relation to pulmonary arterial load is essential for the management of pulmonary hypertension. The pressure‐volume relationship with load manipulation is the gold standard assessment used for this purpose, but its clinical application has been hindered by the lack of a single‐beat method that is valid for the human RV. In the present study, we sought to validate a novel single‐beat method to estimate the preload recruitable stroke work (PRSW) and its derivative for ventriculoarterial coupling in the human RV. Methods and ResultsA novel single‐beat slope of the PRSW relationship (Msw) was derived by calculating the mean ejection pressure when the end‐systolic volume was equal to volume‐axis intercept of the PRSW relationship. In addition, by using a mathematical transformation of the equation representing the linearity of the PRSW relationship, a novel index for ventriculoarterial coupling, Msw/mean ejection pressure, was developed. RV pressure‐volume relationships were measured in 31 patients (including 23 patients with pulmonary hypertension) who were referred for right‐sided heart catheterization. In this cohort, the single‐beat Msw was strongly correlated with the multiple‐beat Msw (r=0.91, P<0.0001). Moreover, a significant correlation was observed between the single‐ and multiple‐beat Msw/mean ejection pressure (r=0.53, P=0.002), with a stronger correlation in those with greater RV systolic pressure (r=0.70, P=0.003). ConclusionsThe novel single‐beat approach provided an accurate estimation of indexes for the PRSW relationship and ventriculoarterial coupling. It may be particularly useful in assessing RV adaptation to increased pressure overload.
format	article
author	Ryo Inuzuka Steven Hsu Ryan J. Tedford Hideaki Senzaki
author_facet	Ryo Inuzuka Steven Hsu Ryan J. Tedford Hideaki Senzaki
author_sort	Ryo Inuzuka
title	Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
title_short	Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
title_full	Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
title_fullStr	Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
title_full_unstemmed	Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension
title_sort	single‐beat estimation of right ventricular contractility and its coupling to pulmonary arterial load in patients with pulmonary hypertension
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/5dc9aab0c9524965972a46a68dbd8837
work_keys_str_mv	AT ryoinuzuka singlebeatestimationofrightventricularcontractilityanditscouplingtopulmonaryarterialloadinpatientswithpulmonaryhypertension AT stevenhsu singlebeatestimationofrightventricularcontractilityanditscouplingtopulmonaryarterialloadinpatientswithpulmonaryhypertension AT ryanjtedford singlebeatestimationofrightventricularcontractilityanditscouplingtopulmonaryarterialloadinpatientswithpulmonaryhypertension AT hideakisenzaki singlebeatestimationofrightventricularcontractilityanditscouplingtopulmonaryarterialloadinpatientswithpulmonaryhypertension
_version_	1718430319739142144

Single‐Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension

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