Dataset for: Ventriculo-Arterial Coupling Detects Occult RV Dysfunction in Chronic Thromboembolic Pulmonary Vascular Disease

Chronic thromboembolic disease (CTED) is sub-optimally defined by a mean pulmonary artery pressure (mPAP) < 25mmHg at rest in patients that remain symptomatic from chronic pulmonary artery thrombi. To improve identification of RV pathology in patients with thromboembolic obstruction, we hypothesized that the right ventricular (RV) ventriculo-arterial (Ees/Ea) coupling ratio at maximal stroke work (Ees/Eamax sw) derived from an animal model of pulmonary obstruction may be used to identify occult RV dysfunction (low Ees/Ea) or residual RV energetic reserve (high Ees/Ea). Eighteen open chested pigs had conductance catheter RV pressure-volume (PV)-loops recorded during PA snare to determine Ees/Eamax sw. This was then applied to ten patients with chronic thromboembolic pulmonary hypertension (CTEPH) and ten patients with CTED, also assessed by RV conductance catheter and cardiopulmonary exercise testing. All patients were then re-stratified by Ees/Ea. The animal model determined an Ees/Eamax sw = 0.68±0.23 threshold, either side of which cardiac output and RV stroke work fell. Two patients with CTED were identified with an Ees/Ea well below 0.68 suggesting occult RV dysfunction whilst three patients with CTEPH demonstrated Ees/Ea ≥ 0.68 suggesting residual RV energetic reserve. Ees/Ea > 0.68 and Ees/Ea < 0.68 sub-groups demonstrated constant RV stroke work but lower stroke volume (87.7±22.1 vs. 60.1±16.3mL respectively, p=0.006) and higher end-systolic pressure (36.7±11.6 vs. 68.1±16.7mmHg respectively, p<0.001). Lower Ees/Ea in CTED also correlated with reduced exercise ventilatory efficiency. Low Ees/Ea aligns with features of RV maladaptation in CTED both at rest and on exercise. Characterisation of Ees/Ea in CTED may allow for better identification of occult RV dysfunction.

慢性血栓栓塞性疾病（Chronic thromboembolic disease, CTED）的现有临床定义不够完善，以静息状态下平均肺动脉压（mean pulmonary artery pressure, mPAP）<25mmHg且仍存在慢性肺动脉血栓相关症状的患者为诊断范畴。为提升对血栓梗阻患者右心室（right ventricular, RV）病理改变的识别效能，本研究提出假说：源自肺动脉梗阻动物模型的最大每搏功状态下右心室-动脉（ventriculo-arterial, Ees/Ea）耦合比（Ees/Eamax sw），可用于甄别隐匿性右心室功能障碍（低Ees/Ea）或残余右心室能量储备（高Ees/Ea）。研究共纳入18只开胸猪，通过肺动脉套扎术（PA snare）期间记录的电导导管右心室压力-容积（pressure-volume, PV）环数据，计算得到Ees/Eamax sw。随后将该临界值应用于10例慢性血栓栓塞性肺动脉高压（chronic thromboembolic pulmonary hypertension, CTEPH）患者与10例CTED患者，所有受试者均接受右心电导导管检查与心肺运动试验，并基于Ees/Ea水平进行重新分层。动物模型实验确定Ees/Eamax sw=0.68±0.23为临界阈值，临界值两侧的心输出量与右心室每搏功均出现显著下降。在CTED患者中，有2例的Ees/Ea显著低于0.68，提示存在隐匿性右心室功能障碍；而3例CTEPH患者的Ees/Ea≥0.68，提示存在残余右心室能量储备。Ees/Ea>0.68与Ees/Ea<0.68两个亚组的右心室每搏功均保持稳定，但每搏输出量分别为87.7±22.1mL与60.1±16.3mL（p=0.006），收缩末期压分别为36.7±11.6mmHg与68.1±16.7mmHg（p<0.001）。CTED患者中更低的Ees/Ea水平还与运动通气效率降低呈显著相关。低Ees/Ea水平与静息及运动状态下CTED患者的右心室适应不良特征相符。对CTED患者的Ees/Ea进行特征分析，有望实现隐匿性右心室功能障碍的精准识别。