Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 39(4): 209-216 (2023)


右室肺動脈カップリングRight Ventricle–Pulmonary Artery Coupling

東邦大学医療センター大森病院 小児科Department of Pediatrics, Toho University Omori Medical Center ◇ Tokyo, Japan

発行日:2023年12月31日Published: December 31, 2023


The normal pulmonary vascular bed is a low-pressure, low-resistance, and high-compliance system. In healthy participants, favorable right ventricle (RV)-to-pulmonary artery (PA) coupling matches RV contractility and RV afterload. RV dysfunction is the most significant predictor of poor prognosis in patients with pulmonary arterial hypertension (PAH). The gold standard for evaluating RV–PA coupling is right heart catheterization, which acquires pressure and volume. Pressure–volume loop-derived end-systolic elastance (Ees) and end-systolic arterial elastance (Ea). RV–PA coupling is the Ees/Es ratio, and a decreased Ees/Ea ratio is a powerful factor in RV dysfunction. The tricuspid annular plane systolic excursion (TAPSE) and estimated systolic pulmonary artery pressure (SPAP) combination has been proposed as a significant prognostic factor in PAH, and the TAPSE/SPAP ratio is a noninvasive index of RV–PA coupling. In compensated states, the RV contractile increases when the afterload increases. In contrast, in decompensated states, the RV contractile function no longer increases when the afterload increases, thereby resulting in lower RV–PA coupling ratios. In patients with severe PAH, early and accurate RV–PA coupling evaluation is essential for clinical decision making.

Key words: pulmonary arterial hypertension; RV–PA coupling; TAPSE; elastance; RV dysfunction

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