Prognostic Significance of Hemodynamics in Patients With Transposition of the Great Arteries and Systemic Right Ventricle.

Autor:	Aldweib N; Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.)., Deghani P; Regina General Hospital, SK, Canada (P.D.)., Broberg CS; Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.)., van Dissel A; Amsterdam University Medical Center, the Netherlands (A.v.D.)., Altibi A; Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.)., Wong J; Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia (J.W., P.S.J., L.J.B., W.M.W.)., Baker D; University of Sydney and Royal Prince Alfred Hospital, NSW, Australia (D.B.)., Gindi S; Children's Hospital of Wisconsin, Milwaukee (S.G.)., Khairy P; Montreal Heart Institute, QC, Canada (P.K.)., Opotowsky AR; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, OH (A.R.O., A.M.L.)., Shah S; Ochsner Medical Center, New Orleans, LA (S.S., M.K., T.G.)., Magalski A; University of Missouri-Kansas City and Saint Luke's Hospital (A.M.)., Cramer J; Children's Hospital, Omaha and University of Nebraska Medical Center (J.C.)., Kauling RM; Erasmus Medical Center, Rotterdam, the Netherlands (R.M.K., J.R.-H.)., Dellborg M; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D.)., Krieger EV; University of Washington Medical Center and Seattle Children's Hospital (E.V.K.)., Yeung E; Colorado University School of Medicine, Denver (E.Y., J.K.)., Roos-Hesselink J; Erasmus Medical Center, Rotterdam, the Netherlands (R.M.K., J.R.-H.)., Aboulhosn J; University of California, Los Angeles Medical Center (J.A.)., Nicolarsen J; Providence Spokane, WA (J.N.)., Masha L; Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.)., Gallego P; Hospital Universitario Virgen Del Rocio, Sevilla, Spain (P.G.)., Celermajer DS; University of Sydney and Royal Prince Alfred Hospital, NSW, Australia (D.S.C.)., Kay J; Colorado University School of Medicine, Denver (E.Y., J.K.)., Vonder Muhll I; University of Alberta, Edmonton, AB, Canada (I.V.M., S.P.)., Jameson SM; Departments of Pediatrics and Medicine, School of Medicine, Stanford University, Palo Alto, CA (S.M.J.)., O'Donnell C; Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, New Zealand (C.O.)., Fusco F; Monaldi Hospital, Napoli, Italy (F.F., B.S.)., John AS; Children's National Hospital, Washington, DC (A.S.J.)., Macon C; Knight Cardiovascular Institute, Oregon Health and Science University, Portland (N.A., C.S.B., A.A., L.M., C.M.)., Antonova P; University Hospital Motol, Prague, Czech Republic (P.A.)., Cotts T; University of Michigan Medical Center, Ann Arbor (T.C.)., Sarubbi B; Monaldi Hospital, Napoli, Italy (F.F., B.S.)., Rodriguez F 3rd; Emory University Hospital, Atlanta, GA (F.R.)., DeZorzi C; Department of Pediatrics, Boston Children's Hospital, and Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.D., C.P.R.M.)., Jayadeva PS; Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia (J.W., P.S.J., L.J.B., W.M.W.)., Kuo M; Ochsner Medical Center, New Orleans, LA (S.S., M.K., T.G.)., Kutty S; Johns Hopkins University, Baltimore, MD (S.K.)., Gupta T; Ochsner Medical Center, New Orleans, LA (S.S., M.K., T.G.)., Burchill LJ; Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia (J.W., P.S.J., L.J.B., W.M.W.)., Rodriguez Monserrate CP; Department of Pediatrics, Boston Children's Hospital, and Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.D., C.P.R.M.)., Lubert AM; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati College of Medicine, OH (A.R.O., A.M.L.)., Grewal J; Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada (J.G.)., Pylypchuk S; University of Alberta, Edmonton, AB, Canada (I.V.M., S.P.)., Belkin MN; University of Chicago, IL (M.N.B.)., Wilson WM; Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia (J.W., P.S.J., L.J.B., W.M.W.).
Jazyk:	angličtina
Zdroj:	Circulation. Heart failure [Circ Heart Fail] 2024 Sep; Vol. 17 (9), pp. e011882. Date of Electronic Publication: 2024 Aug 29.
DOI:	10.1161/CIRCHEARTFAILURE.124.011882
Abstrakt:	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 m 2 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. Competing Interests: None.
Databáze:	MEDLINE
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