Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension

Background: Right ventricular (RV) coupling to the pulmonary circulation influences the response of the RV to the increased afterload caused by pulmonary hypertension (PH), which ultimately determines prognosis. A methodology that accounts for pulsatile flow is required when assessing ventriculo-art...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	K. Wustmann, A. Constantine, J.E. Davies, W. Li, D. Pennell, S.J. Wort, A. Kempny, L.C. Price, C. McCabe, R. Mohiaddin, D.P. Francis, M.A. Gatzoulis, K. Dimopoulos
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Pulmonary hypertension Wave intensity analysis Reservoir pressure Pulmonary ventriculo-arterial coupling Right ventricular function Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/8353d90362db478db10b55d6845c5a91
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:8353d90362db478db10b55d6845c5a91
record_format	dspace
spelling	oai:doaj.org-article:8353d90362db478db10b55d6845c5a912021-11-06T04:37:16ZPrognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension2666-668510.1016/j.ijcchd.2021.100199https://doaj.org/article/8353d90362db478db10b55d6845c5a912021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666668521001233https://doaj.org/toc/2666-6685Background: Right ventricular (RV) coupling to the pulmonary circulation influences the response of the RV to the increased afterload caused by pulmonary hypertension (PH), which ultimately determines prognosis. A methodology that accounts for pulsatile flow is required when assessing ventriculo-arterial coupling. We applied wave intensity analysis (WIA) methods to assess the compliance of the main pulmonary artery (PA) in patients with or without PH and compared this to PA distensibility, RV function and clinical outcomes. Methods: High-fidelity blood pressure and Doppler flow velocity tracings were obtained simultaneously during cardiac catheterisation for suspected PH. RV volumes, main PA distensibility and ventriculo-arterial coupling (Emax/Ea) were analysed using cardiovascular magnetic resonance. Results: The study included 17 PH patients and 6 controls. Wave speed, reservoir and excess pressure were higher in PH patients compared to controls (p < 0.01 for all). Waveforms relating to RV ejection, microvascular wave reflection and late systolic proximal deceleration were higher in PH patients compared to controls (p < 0.01 for all) and related to echocardiographic findings, including PA Doppler notching and shortened acceleration time. Wave speed, reservoir pressure and excess pressure were strongly correlated to main PA distensibility, RV function and Emax/Ea. A higher total pressure integral was associated with an increased risk of death (all-cause mortality). Conclusion: The reservoir-excess pressure model, in combination with conventional clinical imaging, provides valuable information on the pathophysiology of PH that standard haemodynamic parameters do not. Future studies should further investigate the prognostic implications of WIA in PH, and its potential role in clinical practice.K. WustmannA. ConstantineJ.E. DaviesW. LiD. PennellS.J. WortA. KempnyL.C. PriceC. McCabeR. MohiaddinD.P. FrancisM.A. GatzoulisK. DimopoulosElsevierarticlePulmonary hypertensionWave intensity analysisReservoir pressurePulmonary ventriculo-arterial couplingRight ventricular functionDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 5, Iss , Pp 100199- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pulmonary hypertension Wave intensity analysis Reservoir pressure Pulmonary ventriculo-arterial coupling Right ventricular function Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Pulmonary hypertension Wave intensity analysis Reservoir pressure Pulmonary ventriculo-arterial coupling Right ventricular function Diseases of the circulatory (Cardiovascular) system RC666-701 K. Wustmann A. Constantine J.E. Davies W. Li D. Pennell S.J. Wort A. Kempny L.C. Price C. McCabe R. Mohiaddin D.P. Francis M.A. Gatzoulis K. Dimopoulos Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
description	Background: Right ventricular (RV) coupling to the pulmonary circulation influences the response of the RV to the increased afterload caused by pulmonary hypertension (PH), which ultimately determines prognosis. A methodology that accounts for pulsatile flow is required when assessing ventriculo-arterial coupling. We applied wave intensity analysis (WIA) methods to assess the compliance of the main pulmonary artery (PA) in patients with or without PH and compared this to PA distensibility, RV function and clinical outcomes. Methods: High-fidelity blood pressure and Doppler flow velocity tracings were obtained simultaneously during cardiac catheterisation for suspected PH. RV volumes, main PA distensibility and ventriculo-arterial coupling (Emax/Ea) were analysed using cardiovascular magnetic resonance. Results: The study included 17 PH patients and 6 controls. Wave speed, reservoir and excess pressure were higher in PH patients compared to controls (p < 0.01 for all). Waveforms relating to RV ejection, microvascular wave reflection and late systolic proximal deceleration were higher in PH patients compared to controls (p < 0.01 for all) and related to echocardiographic findings, including PA Doppler notching and shortened acceleration time. Wave speed, reservoir pressure and excess pressure were strongly correlated to main PA distensibility, RV function and Emax/Ea. A higher total pressure integral was associated with an increased risk of death (all-cause mortality). Conclusion: The reservoir-excess pressure model, in combination with conventional clinical imaging, provides valuable information on the pathophysiology of PH that standard haemodynamic parameters do not. Future studies should further investigate the prognostic implications of WIA in PH, and its potential role in clinical practice.
format	article
author	K. Wustmann A. Constantine J.E. Davies W. Li D. Pennell S.J. Wort A. Kempny L.C. Price C. McCabe R. Mohiaddin D.P. Francis M.A. Gatzoulis K. Dimopoulos
author_facet	K. Wustmann A. Constantine J.E. Davies W. Li D. Pennell S.J. Wort A. Kempny L.C. Price C. McCabe R. Mohiaddin D.P. Francis M.A. Gatzoulis K. Dimopoulos
author_sort	K. Wustmann
title	Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
title_short	Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
title_full	Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
title_fullStr	Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
title_full_unstemmed	Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
title_sort	prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/8353d90362db478db10b55d6845c5a91
work_keys_str_mv	AT kwustmann prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT aconstantine prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT jedavies prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT wli prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT dpennell prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT sjwort prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT akempny prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT lcprice prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT cmccabe prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT rmohiaddin prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT dpfrancis prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT magatzoulis prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension AT kdimopoulos prognosticimplicationsofpulmonarywavereflectionandreservoirpressureinpatientswithpulmonaryhypertension
_version_	1718443862739910656

Prognostic implications of pulmonary wave reflection and reservoir pressure in patients with pulmonary hypertension

Ejemplares similares