RT Journal Article SR Electronic T1 Right ventriculo-arterial coupling in pulmonary hypertension: a magnetic resonance study JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 238 OP 243 DO 10.1136/heartjnl-2011-300462 VO 98 IS 3 A1 Javier Sanz A1 Ana García-Alvarez A1 Leticia Fernández-Friera A1 Ajith Nair A1 Jesús G Mirelis A1 Simonette T Sawit A1 Sean Pinney A1 Valentin Fuster YR 2012 UL http://heart.bmj.com/content/98/3/238.abstract AB Objective To quantify right ventriculo-arterial coupling in pulmonary hypertension by combining standard right heart catheterisation (RHC) and cardiac magnetic resonance (CMR) and to estimate it non-invasively with CMR alone.Design Cross-sectional analysis in a retrospective cohort of consecutive patients.Setting Tertiary care centre.Patients 139 adults referred for pulmonary hypertension evaluation.Interventions CMR and RHC within 2 days (n=151 test pairs).Main outcome measures Right ventriculo-arterial coupling was quantified as the ratio of pulmonary artery (PA) effective elastance (Ea, index of arterial load) to right ventricular maximal end-systolic elastance (Emax, index of contractility). Right ventricular end-systolic volume (ESV) and stroke volume (SV) were obtained from CMR and adjusted to body surface area. RHC provided mean PA pressure (mPAP) as a surrogate of right ventricular end-systolic pressure, pulmonary capillary wedge pressure (PCWP) and pulmonary vascular resistance index (PVRI). Ea was calculated as (mPAP − PCWP)/SV and Emax as mPAP/ESV.Results Ea increased linearly with advancing severity as defined by PVRI quartiles (0.19, 0.50, 0.93 and 1.63 mm Hg/ml/m2, respectively; p<0.001 for trend) whereas Emax increased initially and subsequently tended to decrease (0.52, 0.67, 0.54 and 0.56 mm Hg/ml/m2; p=0.7). Ea/Emax was maintained early but increased markedly with severe hypertension (0.35, 0.72, 1.76 and 2.85; p<0.001), indicating uncoupling. Ea/Emax approximated non-invasively with CMR as ESV/SV was 0.75, 1.17, 2.28 and 3.51, respectively (p<0.001).Conclusions Right ventriculo-arterial coupling in pulmonary hypertension can be studied with standard RHC and CMR. Arterial load increases with disease severity whereas contractility cannot progress in parallel, leading to severe uncoupling.