Clinical implications of antegrade diastolic pulmonary artery flow in adults

Published:August 12, 2021DOI:https://doi.org/10.1016/j.jjcc.2021.07.010

      Highlights

      • Antegrade diastolic pulmonary artery flow (ADPAF) reflects right ventricular (RV) restriction in adults.
      • ADPAF was found in 0.07% patients who underwent echocardiography in our hospital.
      • ADPAF suggests a less favorable prognosis in patients with RV dysfunction.

      Abstract

      Background

      End-diastolic opening of the pulmonary valve and subsequent antegrade diastolic pulmonary artery flow (ADPAF) reflect restrictive right ventricular (RV) physiology in children. However, this has attracted little attention in adults.

      Purpose

      To clarify the clinical implications of ADPAF in adults.

      Methods and Results

      The study population consisted of 23,049 consecutive adult patients who underwent echocardiography in our hospital between 2008 and 2015. ADPAF was found in 17 patients (0.07%). The simultaneous recording of RV and pulmonary artery pressures revealed marked elevation of RV diastolic pressure, which exceeded pulmonary artery pressure at the time of atrial contraction. These results suggested that ADPAF implies RV restriction. Based on the level of tricuspid annular plane systolic excursion (TAPSE), we classified these patients into two groups: reduced RV function (R-RVF) group (12 patients with TAPSE <17 mm) and preserved RV function (P-RVF) group (5 patients with TAPSE ≥17 mm). In the R-RVF group, four patients died, one patient underwent left ventricular assist device implantation, and two patients underwent unplanned hospitalization for heart failure during follow-up. The R-RVF group had poorer prognosis and higher mortality rate compared with the P-RVF group.

      Conclusions

      ADPAF reflects RV restriction in adults. ADPAF suggests a less favorable prognosis in patients with R-RVF.

      Graphical abstract

      Keywords

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      References

        • Obokata M.
        • Reddy Y.N.V.
        • Melenovsky V.
        • Pislaru S.
        • Borlaug BA.
        Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction.
        Eur Heart J. 2019; 40: 689-697
        • Gorter T.M.
        • van Veldhuisen D.J.
        • Bauersachs J.
        • Borlaug B.A.
        • Celutkiene J.
        • Coats A.J.S.
        • et al.
        Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.
        Eur J Heart Fail. 2018; 20: 16-37
        • Mohammed S.F.
        • Hussain I.
        • AbouEzzeddine O.F.
        • Takahama H.
        • Kwon S.H.
        • Forfia P.
        • et al.
        Right ventricular function in heart failure with preserved ejection fraction: a community-based study.
        Circulation. 2014; 130: 2310-2320
        • Kjaergaard J.
        • Akkan D.
        • Iversen K.K.
        • Kober L.
        • Torp-Pedersen C.
        • Hassager C.
        Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure.
        Eur J Heart Fail. 2007; 9: 610-616
        • Bohbot Y.
        • Guignant P.
        • Rusinaru D.
        • Kubala M.
        • Marechaux S.
        • Tribouilloy C.
        Impact of right ventricular systolic dysfunction on outcome in aortic stenosis.
        Circ Cardiovasc Imaging. 2020; 13e009802
        • Galli E.
        • Guirette Y.
        • Feneon D.
        • Daudin M.
        • Fournet M.
        • Leguerrier A.
        • et al.
        Prevalence and prognostic value of right ventricular dysfunction in severe aortic stenosis.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 531-538
        • Keskin M.
        • Uzun A.O.
        • Hayiroglu M.I.
        • Kaya A.
        • Cinar T.
        • Kozan O.
        The association of right ventricular dysfunction with in-hospital and 1-year outcomes in anterior myocardial infarction.
        Int J Cardiovasc Imaging. 2019; 35: 77-85
        • Antoni M.L.
        • Scherptong R.W.
        • Atary J.Z.
        • Boersma E.
        • Holman E.R.
        • van der Wall E.E.
        • et al.
        Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention.
        Circ Cardiovasc Imaging. 2010; 3: 264-271
        • Gulati A.
        • Ismail T.F.
        • Jabbour A.
        • Alpendurada F.
        • Guha K.
        • Ismail N.A.
        • et al.
        The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy.
        Circulation. 2013; 128: 1623-1633
        • Juilliere Y.
        • Barbier G.
        • Feldmann L.
        • Grentzinger A.
        • Danchin N.
        • Cherrier F.
        Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy.
        Eur Heart J. 1997; 18: 276-280
        • Gibbs J.L.
        • Wilson N.
        • Witsenburg M.
        • Williams G.J.
        • Goldberg S.J.
        Diastolic forward blood flow in the pulmonary artery detected by Doppler echocardiography.
        J Am Coll Cardiol. 1985; 6: 1322-1328
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • Afilalo J.
        • Armstrong A.
        • Ernande L.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Zoghbi W.A.
        • Adams D.
        • Bonow R.O.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • et al.
        Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance.
        J Am Soc Echocardiogr. 2017; 30: 303-371
        • Lancellotti P.
        • Tribouilloy C.
        • Hagendorff A.
        • Popescu B.A.
        • Edvardsen T.
        • Pierard L.A.
        • et al.
        Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of cardiovascular imaging.
        Eur Heart J Cardiovasc Imaging. 2013; 14: 611-644
        • Gatzoulis M.A.
        • Clark A.L.
        • Cullen S.
        • Newman C.G.
        • Redington A.N.
        Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot. Restrictive physiology predicts superior exercise performance.
        Circulation. 1995; 91: 1775-1781
        • Cullen S.
        • Shore D.
        • Redington A.
        Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery.
        Circulation. 1995; 91: 1782-1789
        • Kisanuki A.
        • Tei C.
        • Otsuji Y.
        • Natsugoe K.
        • Kawazoe Y.
        • Arima S.
        • et al.
        Doppler echocardiographic documentation of diastolic pulmonary artery forward flow.
        Am J Cardiol. 1987; 59: 711-713
        • Lam Y.Y.
        • Kaya M.G.
        • Goktekin O.
        • Gatzoulis M.A.
        • Li W.
        • Henein M.Y.
        Restrictive right ventricular physiology: its presence and symptomatic contribution in patients with pulmonary valvular stenosis.
        J Am Coll Cardiol. 2007; 50: 1491-1497
        • Wann L.S.
        • Weyman A.E.
        • Dillon J.C.
        • Feigenbaum H.
        Premature pulmonary valve opening.
        Circulation. 1977; 55: 128-133
        • Deepti S.
        • Gupta S.K.
        • Ramakrishnan S.
        • Talwar S.
        • Kothari SS.
        Constrictive pericarditis following open-heart surgery in a child.
        Ann Pediatr Cardiol. 2016; 9: 68-71
        • Faustino M.
        • Carmo Mendes I.
        • Anjos R.
        Constrictive pericarditis: a challenging diagnosis in pediatrics.
        Case Rep Cardiol. 2015; 2015402740
        • Awasthy N.
        • Bhatt C.
        • Iyer K.S.
        Pandiastolic antegrade flow in patient with severe right ventricle to pulmonary artery conduit stenosis: an interesting phenomenon.
        Ann Pediatr Cardiol. 2016; 9: 82-84
        • Tan Y.
        • Manouras A.
        • Lund L.H.
        • Venkateshvaran A.
        Feasibility and accuracy of tricuspid annular displacement assessed by speckle tracking echocardiography and Doppler tissue imaging.
        Echocardiography. 2019; 36: 2004-2009
        • Miller D.
        • Farah M.G.
        • Liner A.
        • Fox K.
        • Schluchter M.
        • Hoit BD.
        The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance.
        J Am Soc Echocardiogr. 2004; 17: 443-447
        • Rudski L.G.
        • Lai W.W.
        • Afilalo J.
        • Hua L.
        • Handschumacher M.D.
        • Chandrasekaran K.
        • et al.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2010; 23 (quiz 86-8): 685-713
        • Gorter T.M.
        • Hoendermis E.S.
        • van Veldhuisen D.J.
        • Voors A.A.
        • Lam C.S.
        • Geelhoed B.
        • et al.
        Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis.
        Eur J Heart Fail. 2016; 18: 1472-1487
        • Ghio S.
        • Recusani F.
        • Klersy C.
        • Sebastiani R.
        • Laudisa M.L.
        • Campana C.
        • et al.
        Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy.
        Am J Cardiol. 2000; 85: 837-842
        • Burke M.A.
        • Katz D.H.
        • Beussink L.
        • Selvaraj S.
        • Gupta D.K.
        • Fox J.
        • et al.
        Prognostic importance of pathophysiologic markers in patients with heart failure and preserved ejection fraction.
        Circ Heart Fail. 2014; 7: 288-299
      1. Zipes D.P., Libby P.. In: Bonow R.O., Mann D.L., Tomaselli G.F., eds. Cardiac catheterization Braunwald's heart disease: A textbook of cardiovascular medicine, 2-volume set (Braunwald'sHeartDisease). Amsterdam: Elsevier; 2018. p. 359.

        • Szymczyk T.
        • Sauzet O.
        • Paluszkiewicz L.J.
        • Costard-Jackle A.
        • Potratz M.
        • Rudolph V.
        • et al.
        Non-invasive assessment of central venous pressure in heart failure: a systematic prospective comparison of echocardiography and Swan-Ganz catheter.
        Int J Cardiovasc Imaging. 2020; 36: 1821-1829
        • Seo Y.
        • Iida N.
        • Yamamoto M.
        • Machino-Ohtsuka T.
        • Ishizu T.
        • Aonuma K.
        Estimation of central venous pressure using the ratio of short to long diameter from cross-sectional images of the inferior vena cava.
        J Am Soc Echocardiogr. 2017; 30: 461-467