Background

The analysis of right ventriculo-arterial coupling (RVAC) from pressure-volume loops is not routinely performed. RVAC may be approached by the combination of right heart catheterization (RHC) pressure data and cardiac magnetic resonance (CMR)–derived right ventricular (RV) volumetric data. RV pressure and volume measurements by Doppler and three-dimensional echocardiography (3DE) allows another way to approach RVAC.

Methods

Ninety patients suspected of having pulmonary hypertension underwent RHC, 3DE, and CMR (RHC mean pulmonary artery pressure [mPAP] 37.9 ± 11.3 mm Hg; range, 15–66 mm Hg). Three-dimensional (3D) echocardiography was performed in 30 normal patients (echocardiographic mPAP 18.4 ± 3.1 mm Hg). Pulmonary artery (PA) effective elastance (Ea), RV maximal end-systolic elastance (Emax), and RVAC (PA Ea/RV Emax) were calculated from RHC combined with CMR and from 3DE using simplified formulas including mPAP, stroke volume, and end-systolic volume.

Results

Three-dimensional echocardiographic and RHC-CMR measures for PA Ea (3DE, 1.27 ± 0.94; RHC-CMR, 0.71 ± 0.52; r = 0.806, P < .001), RV Emax (3DE, 0.72 ± 0.37; RHC-CMR, 0.38 ± 0.19; r = 0.798, P < .001), and RVAC (3DE, 2.01 ± 1.28; RHC-CMR, 2.32 ± 1.77; r = 0.826, P < .001) were well correlated despite a systematic overestimation of 3DE elastance parameters. Among the whole population, 3D echocardiographic PA Ea and 3D echocardiographic RVAC but not 3D echocardiographic RV Emax were significantly lower in patients with mPAP < 25 mm Hg (n = 41) than in others (n = 79). Among the 90 patients who underwent RHC, 3D echocardiographic PA Ea and 3D echocardiographic RVAC but not 3D echocardiographic RV Emax increased significantly with increasing levels of pulmonary vascular resistance.

Conclusions

Three-dimensional echocardiography–derived PA Ea, RV Emax, and RVAC correlated well with the reference RHC-CMR measurements. Ea and RVAC but not Emax were significantly different between patients with different levels of afterload, suggesting failure of the right ventricle to maintain coupling in severe pulmonary hypertension.

中文翻译：

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三维超声心动图评估右心室-动脉耦合

背景

常规不分析压力-容积环路中的右心室-动脉耦合（RVAC）。右心导管插入（RHC）压力数据和源自心脏磁共振（CMR）的右心室（RV）体积数据的组合可以使用RVAC。通过多普勒和三维超声心动图（3DE）进行RV压力和体积测量可提供另一种接近RVAC的方法。

方法

90名怀疑患有肺动脉高压的患者接受了RHC，3DE和CMR（RHC平均肺动脉压[mPAP] 37.9±11.3 mm Hg；范围15-66 mm Hg）。在30例正常患者中进行了三维（3D）超声心动图检查（超声心动图mPAP为18.4±3.1毫米汞柱）。肺动脉（PA）有效弹性（Ea），RV最大收缩末期弹性（Emax）和RVAC（PA Ea / RV Emax）由RHC与CMR结合使用，并由3DE使用简化的公式（包括mPAP，每搏量和收缩末期容积。

结果

PA Ea的三维超声心动图和RHC-CMR测量（3DE，1.27±0.94; RHC-CMR，0.71±0.52; r  = 0.806，P  <.001），RV Emax（3DE，0.72±0.37; RHC-CMR， 尽管系统地高估了3DE弹性，但0.38±0.19; r  = 0.798，P  <.001）和RVAC（3DE，2.01±1.28; RHC-CMR，2.32±1.77; r  = 0.826，P <.001）很好地相关参数。之间全部人口，三维超声心动图PA Ea和三维超声心动图RVAC但不是三维超声心动图RV的Emax分别显著患者降低与肺动脉压<25毫米汞柱（Ñ  = 41）比在其他（Ñ = 79）。在接受RHC的90例患者中，3D超声心动图PA Ea和3D超声心动图RVAC而非3D超声心动图RV Emax随着肺血管阻力水平的升高而显着增加。

结论

三维超声心动图得出的PA Ea，RV Emax和RVAC与参考RHC-CMR测量值相关性很好。在不同水平的后负荷患者中，Ea和RVAC差异无统计学意义，但Emax差异不显着，这表明严重肺动脉高压患者右心室无法维持偶联。