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Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy

  • Christine A. Capone
  • Jacqueline M. Lamour
  • Josemiguel Lorenzo
  • Barbara Tria
  • Kenny Ye
  • Daphne T. Hsu
  • Joseph Mahgerefteh
Original Article
  • 33 Downloads

Abstract

In adult heart failure (HF) patients, a higher ventricular arterial (VA) coupling ratio measured non-invasively is associated with worse HF prognosis and response to treatment. There are no data regarding the relationship of VA coupling to outcome in pediatric dilated cardiomyopathy (DCM) patients. We investigated the association of VA coupling ratio with worse outcome (mechanical circulatory support, transplant, or death) in 48 children with DCM and 97 age-gender matched controls. Mean age at presentation was 9 ± 7 years; DCM patients had a higher arterial elastance (3.8 ± 1.7 vs 2.7 ± 0.7 respectively p = 0.001), a lower LV elastance (1.1 ± 0.65 vs 4.5 ± 1.4, respectively p = 0.001) and higher VA coupling ratio (5.0 ± 3.9 vs 0.34 ± 0.14, respectively p = 0.001). Outcome events occurred in 27/48 (56%) patients. Patients with an outcome event had a higher NYHA class (p = 0.001), lower LV elastance (0.8 ± 0.47 vs 1.6 ± 0.57, respectively p = 0.001), higher arterial elastance (4.5 ± 1.8 vs 2.9 ± 1.1, respectively p = 0.002), and a higher VA coupling ratio (7.1 ± 3.8 vs 2.2 ± 1.5, respectively p = 0.001) compared to those without. In a multivariate CART analysis, VA coupling was the top and only discriminator of poor outcome. In conclusion, a higher VA coupling ratio is associated with worse outcome in pediatric patients with DCM. VA coupling is promising as a bedside analysis tool that may provide insight into the mechanisms of HF in pediatric DCM and identify potential targets for therapy.

Keywords

Pediatrics Cardiomyopathy Heart transplantation Ventricular arterial coupling Echocardiography 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christine A. Capone
    • 1
  • Jacqueline M. Lamour
    • 1
  • Josemiguel Lorenzo
    • 1
  • Barbara Tria
    • 1
  • Kenny Ye
    • 2
  • Daphne T. Hsu
    • 1
  • Joseph Mahgerefteh
    • 1
  1. 1.Division of Pediatric Cardiology, Department of PediatricsThe Children’s Hospital at Montefiore, Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA

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