Rahi S Alipour Symakani, Wouter J van Genuchten, Lotte M Zandbergen, Alexander Hirsch, Piotr Wielopolski, Thierry Bové, Yannick J H J Taverne, Willem A Helbing, Beatrijs Bartelds, Daphne Merkus
{"title":"经环形补片修复肺动脉狭窄后肺返流的心室-动脉耦合。","authors":"Rahi S Alipour Symakani, Wouter J van Genuchten, Lotte M Zandbergen, Alexander Hirsch, Piotr Wielopolski, Thierry Bové, Yannick J H J Taverne, Willem A Helbing, Beatrijs Bartelds, Daphne Merkus","doi":"10.1152/ajpheart.00614.2024","DOIUrl":null,"url":null,"abstract":"<p><p>Pulmonary regurgitation is a common consequence following the repair of tetralogy of Fallot and can lead to heart failure. Early detection of right ventricular dysfunction remains challenging, and current clinical markers have limited predictive value to identify which patients are at risk for heart failure and require interventions. This study aimed to investigate the potential of ventriculo-arterial coupling as a marker of early right ventricular dysfunction in a porcine model of chronic pulmonary regurgitation following transannular patch repair of neonatal pulmonary stenosis. Neonatal swine were subjected to pulmonary artery banding for 1 mo to induce right ventricular (RV) pressure overload, followed by transannular patch repair (rTAP, <i>n</i> = 10) to create chronic pulmonary regurgitation, and were compared with Sham animals (<i>n</i> = 6). Longitudinal hemodynamic assessments, including pressure-volume analysis and cardiac magnetic resonance imaging, were performed. Ventriculo-arterial coupling (VAC) was defined as the ratio of end-systolic elastance to effective arterial elastance. Over the follow-up period of 4 mo, VAC was preserved in the rTAP group. Effective arterial elastance was significantly lower in rTAP animals (<i>P</i> = 0.001), whereas end-systolic elastance remained unchanged. Lower end-diastolic pulmonary artery pressures and increased early systolic ejection were observed in rTAP, correlating with higher VAC. Ventriculo-arterial coupling remains preserved in chronic pulmonary regurgitation due to decreased afterload, making it unsuitable as an early marker for right ventricular dysfunction. Low afterload, a consequence of diastolic emptying of the pulmonary artery into the right ventricle, may pseudo-normalize systolic function. Alternative markers, for example, focusing on diastolic function and atrio-ventricular interactions should be investigated.<b>NEW & NOTEWORTHY</b> We used a porcine model of sequential loading with pulmonary artery banding and transannular patch mimicking tetralogy of Fallot to test ventriculo-arterial coupling as a marker of early right ventricular dysfunction. Ventriculo-arterial coupling is preserved despite right ventricular dysfunction and afterload is decreased. Pulmonary regurgitation results in low afterload following pulmonary artery pressure drop during diastole. Early systolic ejection is increased and correlates with ventriculo-arterial coupling.</p>","PeriodicalId":7692,"journal":{"name":"American journal of physiology. Heart and circulatory physiology","volume":" ","pages":"H1054-H1064"},"PeriodicalIF":4.1000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ventriculo-arterial coupling in pulmonary regurgitation following transannular patch repair of pulmonary stenosis.\",\"authors\":\"Rahi S Alipour Symakani, Wouter J van Genuchten, Lotte M Zandbergen, Alexander Hirsch, Piotr Wielopolski, Thierry Bové, Yannick J H J Taverne, Willem A Helbing, Beatrijs Bartelds, Daphne Merkus\",\"doi\":\"10.1152/ajpheart.00614.2024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Pulmonary regurgitation is a common consequence following the repair of tetralogy of Fallot and can lead to heart failure. Early detection of right ventricular dysfunction remains challenging, and current clinical markers have limited predictive value to identify which patients are at risk for heart failure and require interventions. This study aimed to investigate the potential of ventriculo-arterial coupling as a marker of early right ventricular dysfunction in a porcine model of chronic pulmonary regurgitation following transannular patch repair of neonatal pulmonary stenosis. Neonatal swine were subjected to pulmonary artery banding for 1 mo to induce right ventricular (RV) pressure overload, followed by transannular patch repair (rTAP, <i>n</i> = 10) to create chronic pulmonary regurgitation, and were compared with Sham animals (<i>n</i> = 6). Longitudinal hemodynamic assessments, including pressure-volume analysis and cardiac magnetic resonance imaging, were performed. Ventriculo-arterial coupling (VAC) was defined as the ratio of end-systolic elastance to effective arterial elastance. Over the follow-up period of 4 mo, VAC was preserved in the rTAP group. Effective arterial elastance was significantly lower in rTAP animals (<i>P</i> = 0.001), whereas end-systolic elastance remained unchanged. Lower end-diastolic pulmonary artery pressures and increased early systolic ejection were observed in rTAP, correlating with higher VAC. Ventriculo-arterial coupling remains preserved in chronic pulmonary regurgitation due to decreased afterload, making it unsuitable as an early marker for right ventricular dysfunction. Low afterload, a consequence of diastolic emptying of the pulmonary artery into the right ventricle, may pseudo-normalize systolic function. Alternative markers, for example, focusing on diastolic function and atrio-ventricular interactions should be investigated.<b>NEW & NOTEWORTHY</b> We used a porcine model of sequential loading with pulmonary artery banding and transannular patch mimicking tetralogy of Fallot to test ventriculo-arterial coupling as a marker of early right ventricular dysfunction. Ventriculo-arterial coupling is preserved despite right ventricular dysfunction and afterload is decreased. Pulmonary regurgitation results in low afterload following pulmonary artery pressure drop during diastole. Early systolic ejection is increased and correlates with ventriculo-arterial coupling.</p>\",\"PeriodicalId\":7692,\"journal\":{\"name\":\"American journal of physiology. 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Heart and circulatory physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1152/ajpheart.00614.2024","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Ventriculo-arterial coupling in pulmonary regurgitation following transannular patch repair of pulmonary stenosis.
Pulmonary regurgitation is a common consequence following the repair of tetralogy of Fallot and can lead to heart failure. Early detection of right ventricular dysfunction remains challenging, and current clinical markers have limited predictive value to identify which patients are at risk for heart failure and require interventions. This study aimed to investigate the potential of ventriculo-arterial coupling as a marker of early right ventricular dysfunction in a porcine model of chronic pulmonary regurgitation following transannular patch repair of neonatal pulmonary stenosis. Neonatal swine were subjected to pulmonary artery banding for 1 mo to induce right ventricular (RV) pressure overload, followed by transannular patch repair (rTAP, n = 10) to create chronic pulmonary regurgitation, and were compared with Sham animals (n = 6). Longitudinal hemodynamic assessments, including pressure-volume analysis and cardiac magnetic resonance imaging, were performed. Ventriculo-arterial coupling (VAC) was defined as the ratio of end-systolic elastance to effective arterial elastance. Over the follow-up period of 4 mo, VAC was preserved in the rTAP group. Effective arterial elastance was significantly lower in rTAP animals (P = 0.001), whereas end-systolic elastance remained unchanged. Lower end-diastolic pulmonary artery pressures and increased early systolic ejection were observed in rTAP, correlating with higher VAC. Ventriculo-arterial coupling remains preserved in chronic pulmonary regurgitation due to decreased afterload, making it unsuitable as an early marker for right ventricular dysfunction. Low afterload, a consequence of diastolic emptying of the pulmonary artery into the right ventricle, may pseudo-normalize systolic function. Alternative markers, for example, focusing on diastolic function and atrio-ventricular interactions should be investigated.NEW & NOTEWORTHY We used a porcine model of sequential loading with pulmonary artery banding and transannular patch mimicking tetralogy of Fallot to test ventriculo-arterial coupling as a marker of early right ventricular dysfunction. Ventriculo-arterial coupling is preserved despite right ventricular dysfunction and afterload is decreased. Pulmonary regurgitation results in low afterload following pulmonary artery pressure drop during diastole. Early systolic ejection is increased and correlates with ventriculo-arterial coupling.
期刊介绍:
The American Journal of Physiology-Heart and Circulatory Physiology publishes original investigations, reviews and perspectives on the physiology of the heart, vasculature, and lymphatics. These articles include experimental and theoretical studies of cardiovascular function at all levels of organization ranging from the intact and integrative animal and organ function to the cellular, subcellular, and molecular levels. The journal embraces new descriptions of these functions and their control systems, as well as their basis in biochemistry, biophysics, genetics, and cell biology. Preference is given to research that provides significant new mechanistic physiological insights that determine the performance of the normal and abnormal heart and circulation.