Echocardiographic Grading of Right Ventricular Afterload in Left Heart Disease : Relation to Right Ventricular Function, Pulsatile and Resistant Load, and Outcome
(2024) In Pulmonary Circulation 14(4).- Abstract
The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance. The aims of the present study on patients with left heart disease, were to evaluate a novel echocardiographic right ventricular (RV) afterload score and to investigate its relation to risk of mortality or implantation of a left ventricular assist device. Patients (n = 220) with left ventricular ejection fraction < 50% consecutively referred for heart transplant or heart failure workup underwent echocardiography and right heart catheterization. Four metrics were included in the... (More)
The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance. The aims of the present study on patients with left heart disease, were to evaluate a novel echocardiographic right ventricular (RV) afterload score and to investigate its relation to risk of mortality or implantation of a left ventricular assist device. Patients (n = 220) with left ventricular ejection fraction < 50% consecutively referred for heart transplant or heart failure workup underwent echocardiography and right heart catheterization. Four metrics were included in the afterload score: the systolic pulmonary artery pressure (sPAPDoppler) and three variables related to pressure reflection in the pulmonary circulation. Two points were allocated for sPAPDoppler ≥ 60 mmHg and for each pressure reflection variable indicating PVR > 3 Wood units (WU). One point was allocated for sPAPDoppler 36–59 mmHg and for pressure reflection variables above the upper normal limit. Low afterload was defined as 0-to-1 points, intermediate as 2-to-4 points, and high as 5-to-8 points. There were in-between the groups significant differences in PAC and PVR. A 5-point RV dysfunction score showed with stepwise increased RV afterload more severe dysfunction. Unadjusted hazard ratio for endpoint was 3.34 (1.69–6.79) for intermediate score, and 5.11 (2.52–10.40) for patients with high score. In conclusion, in patients with severe heart failure, a novel echocardiographic RV afterload score is related to increased pulsatile and resistant load, more severe RV dysfunction, and increased risk of adverse outcome.
(Less)
- author
- Bech-Hanssen, Odd ; Lindow, Thomas LU ; Astengo, Marco ; Bollano, Entela and Ricksten, Sven Erik
- organization
- publishing date
- 2024-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- echocardiography, left heart disease, right ventricular afterload, right ventricular dysfunction
- in
- Pulmonary Circulation
- volume
- 14
- issue
- 4
- article number
- e70029
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85212477916
- pmid:39711998
- ISSN
- 2045-8932
- DOI
- 10.1002/pul2.70029
- language
- English
- LU publication?
- yes
- id
- 16860511-e194-4a60-9cd5-afe294e8d845
- date added to LUP
- 2025-01-22 10:51:48
- date last changed
- 2025-07-10 00:34:39
@article{16860511-e194-4a60-9cd5-afe294e8d845,
abstract = {{<p>The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance. The aims of the present study on patients with left heart disease, were to evaluate a novel echocardiographic right ventricular (RV) afterload score and to investigate its relation to risk of mortality or implantation of a left ventricular assist device. Patients (n = 220) with left ventricular ejection fraction < 50% consecutively referred for heart transplant or heart failure workup underwent echocardiography and right heart catheterization. Four metrics were included in the afterload score: the systolic pulmonary artery pressure (sPAP<sub>Doppler</sub>) and three variables related to pressure reflection in the pulmonary circulation. Two points were allocated for sPAP<sub>Doppler</sub> ≥ 60 mmHg and for each pressure reflection variable indicating PVR > 3 Wood units (WU). One point was allocated for sPAP<sub>Doppler</sub> 36–59 mmHg and for pressure reflection variables above the upper normal limit. Low afterload was defined as 0-to-1 points, intermediate as 2-to-4 points, and high as 5-to-8 points. There were in-between the groups significant differences in PAC and PVR. A 5-point RV dysfunction score showed with stepwise increased RV afterload more severe dysfunction. Unadjusted hazard ratio for endpoint was 3.34 (1.69–6.79) for intermediate score, and 5.11 (2.52–10.40) for patients with high score. In conclusion, in patients with severe heart failure, a novel echocardiographic RV afterload score is related to increased pulsatile and resistant load, more severe RV dysfunction, and increased risk of adverse outcome.</p>}},
author = {{Bech-Hanssen, Odd and Lindow, Thomas and Astengo, Marco and Bollano, Entela and Ricksten, Sven Erik}},
issn = {{2045-8932}},
keywords = {{echocardiography; left heart disease; right ventricular afterload; right ventricular dysfunction}},
language = {{eng}},
number = {{4}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Pulmonary Circulation}},
title = {{Echocardiographic Grading of Right Ventricular Afterload in Left Heart Disease : Relation to Right Ventricular Function, Pulsatile and Resistant Load, and Outcome}},
url = {{http://dx.doi.org/10.1002/pul2.70029}},
doi = {{10.1002/pul2.70029}},
volume = {{14}},
year = {{2024}},
}