TY - JOUR
T1 - Prognostic Significance of Hemodynamics in Patients With Transposition of the Great Arteries and Systemic Right Ventricle
AU - Aldweib, Nael
AU - Deghani, Payam
AU - Broberg, Craig S.
AU - van Dissel, Alexandra
AU - Altibi, Ahmad
AU - Wong, Joshua
AU - Baker, David
AU - Gindi, Salil
AU - Khairy, Paul
AU - Opotowsky, Alexander R.
AU - Shah, Sangeeta
AU - Magalski, Anthony
AU - Cramer, Jonathan
AU - Kauling, Robert M.
AU - Dellborg, Mikael
AU - Krieger, Eric V.
AU - Yeung, Elizabeth
AU - Roos-Hesselink, Jolien
AU - Aboulhosn, Jamil
AU - Nicolarsen, Jeremy
AU - Masha, Luke
AU - Gallego, Pastora
AU - Celermajer, David S.
AU - Kay, Joseph
AU - Vonder Muhll, Isabelle
AU - Jameson, Susan M.
AU - O’Donnell, Clare
AU - Fusco, Flavia
AU - John, Anitha S.
AU - Macon, Conrad
AU - Antonova, Petra
AU - Cotts, Timothy
AU - Sarubbi, Berardo
AU - Rodriguez, Fred
AU - DeZorzi, Christopher
AU - Jayadeva, Pavithra S.
AU - Kuo, Marissa
AU - Kutty, Shelby
AU - Gupta, Tripti
AU - Burchill, Luke J.
AU - Rodriguez Monserrate, Carla P.
AU - Lubert, Adam M.
AU - Grewal, Jasmine
AU - Pylypchuk, Stephen
AU - Belkin, Mark N.
AU - Wilson, William M.
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2024/9/1
Y1 - 2024/9/1
N2 - BACKGROUND: Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle. METHODS: This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m2 signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support. RESULTS: Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5–15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01–11.62; P<0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63–9.02; P<0.001). CONCLUSIONS: A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.
AB - BACKGROUND: Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle. METHODS: This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m2 signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support. RESULTS: Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5–15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01–11.62; P<0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63–9.02; P<0.001). CONCLUSIONS: A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.
KW - arterial pressure
KW - cardiac catheterization
KW - cardiac output
KW - congenitally corrected transposition of the great arteries
KW - heart ventricles
KW - hemodynamics
KW - pulmonary wedge pressure
KW - stroke volume
UR - https://www.scopus.com/pages/publications/85202763884
U2 - 10.1161/CIRCHEARTFAILURE.124.011882
DO - 10.1161/CIRCHEARTFAILURE.124.011882
M3 - Article
C2 - 39206568
AN - SCOPUS:85202763884
SN - 1941-3289
VL - 17
SP - e011882
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 9
ER -