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Ventricular-Vascular Coupling in the Pulmonary Circulation

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Right Ventricular Physiology, Adaptation and Failure in Congenital and Acquired Heart Disease

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Abstract

Ventricular performance quantities such as the end-systolic pressure-volume relationship (ESPVR) have been the subject of numerous basic science studies, yet their clinical use remains limited, particularly in the right ventricle (RV). This is primarily due to the difficulty of volume measurements in the small, crescent-shaped RV via catheterization. However, such parameters should be a superior indicator of ventricular function compared with other hemodynamic measures used in the prognosis of pulmonary arterial hypertension (PAH), such as pulmonary vascular resistance index (PVRI). Thus, there is clinical interest in methods that estimate ESPVR and related parameters while being minimally invasive. The focus of this chapter is on one such method and its possible non-invasive extensions, a modified single-beat method which estimates the ventricular-vascular coupling ratio (VVCR), or the ratio of end-systolic ventricular elastance (Ees) to arterial elastance (Ea). Within the single-beat elastance framework, the maximum isovolumic pressure (Pmax,iso) and end-systolic pressure are found; based on a novel assumption about the slopes of Ees and Ea, VVCR is then computed using only pressure. A lower coupling ratio is hypothesized to be a good indicator of RV dysfunction and failure, as represented by the World Health Organization Functional Class (WHO-FC). We also investigate two non-invasive forms of this method using measurements in children: one in which pressure data is obtained from the velocity of the tricuspid regurgitant (TR) jet measured by Doppler ultrasound; and another in which myocardial performance index (MPI) is used to approximate VVCR. Finally, a very new but existing noninvasive method to compute VVCR using only volumes is explored as a predictor of reactivity in children with PH.

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Authors and Affiliations

  1. Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA

    Nicholas E. Hobson & Kendall S. Hunter

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  1. Nicholas E. Hobson
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  2. Kendall S. Hunter
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Correspondence to Kendall S. Hunter .

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Editors and Affiliations

  1. Paediatric Cardiology, Labatt Family Heart Center Hospital for Sick Children, Toronto, Ontario, Canada

    Mark K. Friedberg

  2. Heart Institute, Cincinnati Children’s Hosp Med Center, Cincinnati, Ohio, USA

    Andrew N. Redington

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Hobson, N.E., Hunter, K.S. (2018). Ventricular-Vascular Coupling in the Pulmonary Circulation. In: Friedberg, M., Redington, A. (eds) Right Ventricular Physiology, Adaptation and Failure in Congenital and Acquired Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-67096-6_5

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  • DOI: https://doi.org/10.1007/978-3-319-67096-6_5

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