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

Christine A Capone1, Jacqueline M Lamour2, Josemiguel Lorenzo2

  • 1Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA. christine.capone@gmail.com.

Pediatric Cardiology
|November 12, 2018
PubMed

Insights

A higher ventricular arterial (VA) coupling ratio is linked to worse outcomes in children with dilated cardiomyopathy (DCM). This non-invasive measure may help predict heart failure progression and guide treatment in pediatric DCM patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiovascular Physiology

Background:

  • Ventricular arterial (VA) coupling is a known predictor of outcomes in adult heart failure (HF).
  • Limited data exist on the association of VA coupling with prognosis in pediatric dilated cardiomyopathy (DCM).

Purpose of the Study:

  • To investigate the relationship between the VA coupling ratio and adverse outcomes in pediatric DCM patients.
  • To determine if VA coupling can predict the need for mechanical circulatory support, transplant, or death in children with DCM.

Main Methods:

  • A case-control study involving 48 pediatric DCM patients and 97 age-gender matched controls.
  • Non-invasive measurement of VA coupling ratio, arterial elastance, and left ventricular (LV) elastance.
  • Multivariate analysis, including CART analysis, to identify predictors of outcome.

Main Results:

  • DCM patients exhibited higher arterial elastance, lower LV elastance, and a significantly higher VA coupling ratio compared to controls.
  • Patients experiencing adverse outcomes (mechanical support, transplant, or death) had higher NYHA class, lower LV elastance, higher arterial elastance, and a markedly elevated VA coupling ratio.
  • VA coupling ratio was identified as the sole and primary discriminator of poor outcome in multivariate CART analysis.

Conclusions:

  • An elevated VA coupling ratio is significantly associated with worse outcomes in pediatric DCM.
  • VA coupling shows promise as a bedside tool for assessing pediatric DCM severity and guiding therapeutic strategies.
  • Further research into VA coupling may elucidate mechanisms of pediatric HF and identify novel treatment targets.

Keywords:
CardiomyopathyEchocardiographyHeart transplantationPediatricsVentricular arterial coupling

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