부산대학교 도서관

Introduction: Right ventricular-pulmonary arterial coupling (RV-AP-coup) plays a role in the occurrence of right ventricular failure. Ventricular-arterial coupling is defined as Emax (maximal systolic ventricular elastance)/Ea (arterial elastance). Emax/Ea can be measured using cardiac magnetic resonance (CMR) as = stroke volume/end-systolic volume.Hypothesis: Preoperative RV-AP-coup predicts changes of RV ejection fraction after pulmonary valve implantation (PVI) because of pulmonary valve dysfunction (PVDysf).Methods: We evaluated 124 patients (age 25+/-12 years; BSA 1.23+/-0.84) treated because of PVDysf (prevalent regurgitation, prevalent stenosis or both) and underwent PVI (surgical or transcatheter). CMR studies were performed before and 12 months after PVI.Results: Forty-nine subjects were submitted to a surgical procedure while 75 underwent a transcatheter approach. RV volumes reduced significantly (RVEDD pre 109+/-43 vs post 93+/-23; p=0.001; RVESD pre 55+/-32 vs 44+/-18; p=0.01). RV stroke volume reduced (55+/-19 vs 49+/-10; p=0.01) while RV-AP-coup improved significantly (pre 0.76+/-0.6 versus post 1.5+/-0.95; p<0.001). Left ventricular coupling did not change. Post-procedural RV ejection fraction was significantly correlated to basal coupling (r2=0.4; p<0.0001). Two groups of basal coupling were created (Group A: coupling<1.3; Group B coupling>1.3). Subjects with lower pre-operative coupling had lower post-operative RV ejection fraction (Group A: 50+/-1%; Group B:61+/-1.8 %; p<0.0001). No relationships were found with age at procedure, sex, group of treatment, subgroups of pulmonary valve dysfunction.Conclusions: In our series, patients undergoing PVI improve significantly RV-AP-coup. Basal RV-AP-coup predicts post-operative RV ejection fraction.