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Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy
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  • Aura Vijiiac,
  • Sebastian Onciul,
  • Silvia Deaconu,
  • Radu Vatasescu,
  • Claudia Guzu,
  • Violeta Verinceanu,
  • Alina Scarlatescu,
  • Diana Zamfir,
  • Ioana Petre,
  • Alexandru Scafa Udriste,
  • Maria Dorobantu
Aura Vijiiac
Carol Davila University of Medicine and Pharmacy

Corresponding Author:aura.apostolescu@yahoo.com

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Sebastian Onciul
Carol Davila University of Medicine and Pharmacy
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Silvia Deaconu
Emergency Clinical Hospital of Bucharest
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Radu Vatasescu
Clinical Emergency Hospital Bucharest
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Claudia Guzu
Emergency Clinical Hospital, Bucharest
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Violeta Verinceanu
Emergency Clinical Hospital Bucharest
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Alina Scarlatescu
Emergency Clinical Hospital, Bucharest
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Diana Zamfir
Emergency Clinical Hospital, Bucharest
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Ioana Petre
Carol Davila University of Medicine and Pharmacy
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Alexandru Scafa Udriste
Carol Davila University of Medicine and Pharmacy
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Maria Dorobantu
Carol Davila University of Medicine and Pharmacy
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Abstract

Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.
09 Sep 2021Submitted to Echocardiography
11 Sep 2021Submission Checks Completed
11 Sep 2021Assigned to Editor
15 Sep 2021Reviewer(s) Assigned
26 Oct 2021Review(s) Completed, Editorial Evaluation Pending
05 Nov 2021Editorial Decision: Revise Major
15 Nov 20211st Revision Received
16 Nov 2021Submission Checks Completed
16 Nov 2021Assigned to Editor
16 Nov 2021Reviewer(s) Assigned
21 Nov 2021Review(s) Completed, Editorial Evaluation Pending
24 Nov 2021Editorial Decision: Revise Minor
03 Dec 20212nd Revision Received
04 Dec 2021Submission Checks Completed
04 Dec 2021Assigned to Editor
04 Dec 2021Reviewer(s) Assigned
12 Dec 2021Review(s) Completed, Editorial Evaluation Pending
16 Dec 2021Editorial Decision: Accept