Evaluation of right ventricle pulmonary artery coupling on right ventricular function in post operative tetralogy of Fallot patients underwent for pulmonary valve replacement

Abstract

Background To evaluate RV-PA coupling in post operative TOF patients with ventricular dilatation underwent for PVR and investigate the correlation between ventricular functions measuring Ea/Emax ratio using cardio magnetic resonance and the effect of surgical type at primary repair of TOF on coupling. Method RV-PA coupling was measured noninvasively by Ea/Emax ratio from CMRI and ECHO. From CMRI results the patients were divided in two groups, RV-PA coupling and RV-PA uncoupling. Ea/Emax ≤1 was considered for coupling patients and Ea/Emax > 1 for uncoupling patients. Results Ninety patients were uncoupled (Ea/Emax: 1.55 ± 0.46) and 45 were coupled (Ea/Emax: 0.81 ± 0.15). Out of 75 TAP repaired patients 60 were uncoupled RV-PV. In addition, higher pro-BNP is an important factor for uncoupled RV-PV (P = 0.001). CMR evaluation for right ventricular function between uncoupling and coupling were RVEDVi (196.65 ± 63.57 vs. 154.28 ± 50.07, P = 0.001), RVESVi (121.19 ± 51.47 vs. 83.94 ± 20.43, P = 0.001), RVSVi (67.19 ± 19.87 vs. 106.31 ± 33.44, P = 0.001), and RVEF (40.90 ± 8.73 vs. 54.63 ± 4.76, P = 0.001). The increased RVEDVi, RVESVi and RVSVi and decreased RVEF have significant correlation with Ea/Emax. Ea/Emax was also found positively correlated with RVEDVi (P = < 0.05, r = 0.35), RVESVi (P = < 0.001, r = 0.41) and negatively correlated with RVSVi (P = < 0.05, r = 0.22) and RVEF (P = < 0.05, r = 0.78). Conclusions Unfavorable RV-PA coupling is present in post operative TOF patients and it is affected by several factors. Our results explain a new concept of RV-PA interactions as a contributing mechanism for the observed decline in RV function.

Application of an echocardiographic index to characterize right ventricular–pulmonary arterial coupling in heart failure

“…found that long‐term follow‐up TAPSE/PASP assessment of RV–PA coupling was simple, applicable, and significant to prognosis, suggesting that RV–PA uncoupling is common amongst these patients 114 . Their results aligned with those of previous studies that analysed RV–PA coupling in similar individuals but employed Ees/Ea 115,116 . TAPSE/PASP detects subclinical RV dysfunction in patients after TOF repair, consequently preventing poor cardiovascular outcomes 117 .…”

“…114 Their results aligned with those of previous studies that analysed RV-PA coupling in similar individuals but employed Ees/Ea. 115,116 TAPSE/PASP detects subclinical RV dysfunction in patients after TOF repair, consequently preventing poor cardiovascular outcomes. 117 Egbe et al 118 measured TAPSE/PASP in 84 patients with persistent pulmonary regurgitation post-operatively with repaired TOF.…”

Color tissue doppler imaging of tricuspid annular plane systolic and diastolic excursion in children: A comparison of normal, volume‐overloaded and pressure overloaded right ventricles

“…[52][53][54] The difference in RV response to these two types of volume overload may be explained by abnormal right ventricular-pulmonary arterial (RV-PA) coupling in pulmonary regurgitation. 55,56 RV can increase its contractility up to five times of baseline value in PH. After that, the RV dilates to limit the decrease in the stroke volume.…”

The right ventricle in tetralogy of Fallot: adaptation to sequential loading

“…Of note, these different studies use different methods, so direct comparison is impossible. A recent study has published on ventriculo-arterial coupling in rTOF, non-invasively assessed by using cardiac magnetic resonance (CMR) derived RV volumes only ( 40 ). The need for pressures in the equation is supposedly eliminated by forcing the linear regression of the end-systolic pressure volume relation through the origin.…”