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Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy

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Abstract

In adult heart failure (HF) patients, a higher ventricular arterial (VA) coupling ratio measured non-invasively is associated with worse HF prognosis and response to treatment. There are no data regarding the relationship of VA coupling to outcome in pediatric dilated cardiomyopathy (DCM) patients. We investigated the association of VA coupling ratio with worse outcome (mechanical circulatory support, transplant, or death) in 48 children with DCM and 97 age-gender matched controls. Mean age at presentation was 9 ± 7 years; DCM patients had a higher arterial elastance (3.8 ± 1.7 vs 2.7 ± 0.7 respectively p = 0.001), a lower LV elastance (1.1 ± 0.65 vs 4.5 ± 1.4, respectively p = 0.001) and higher VA coupling ratio (5.0 ± 3.9 vs 0.34 ± 0.14, respectively p = 0.001). Outcome events occurred in 27/48 (56%) patients. Patients with an outcome event had a higher NYHA class (p = 0.001), lower LV elastance (0.8 ± 0.47 vs 1.6 ± 0.57, respectively p = 0.001), higher arterial elastance (4.5 ± 1.8 vs 2.9 ± 1.1, respectively p = 0.002), and a higher VA coupling ratio (7.1 ± 3.8 vs 2.2 ± 1.5, respectively p = 0.001) compared to those without. In a multivariate CART analysis, VA coupling was the top and only discriminator of poor outcome. In conclusion, a higher VA coupling ratio is associated with worse outcome in pediatric patients with DCM. VA coupling is promising as a bedside analysis tool that may provide insight into the mechanisms of HF in pediatric DCM and identify potential targets for therapy.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA

    Christine A. Capone, Jacqueline M. Lamour, Josemiguel Lorenzo, Barbara Tria, Daphne T. Hsu & Joseph Mahgerefteh

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Kenny Ye

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  1. Christine A. Capone
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  2. Jacqueline M. Lamour
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  3. Josemiguel Lorenzo
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  5. Kenny Ye
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Correspondence to Christine A. Capone.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study formal consent is not required.

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Capone, C.A., Lamour, J.M., Lorenzo, J. et al. Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy. Pediatr Cardiol 40, 330–338 (2019). https://doi.org/10.1007/s00246-018-2021-6

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  • DOI: https://doi.org/10.1007/s00246-018-2021-6

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