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| Name | Class |
|---|---|
| University of Minnesota | OTHER |
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The right ventricular (RV) systolic function is a key determinant of outcome in patients with pulmonary hypertension and elevated pulmonary vascular resistance. As the pulmonary artery pressure and vascular resistance increase (i.e. RV afterload) in these patients, so does the right ventricular contractility in an attempt to maintain cardiac output. This is response of a ventricle to its afterload is termed ventriculo-arterial (VA) coupling. However, there is a limit to this increase in contractility after which VA uncoupling occurs ultimately leading to decrease cardiac output and right ventricular failure. The accepted gold standard for measurement of VA coupling is the ratio of the end systolic ventricular elastance (Ees) to the end systolic arterial elastance (Ea) measured invasively via high fidelity conductance catheters during cardiac catheterization. In this study, the aim is to devise a non-invasive scoring system that can identify VA uncoupling in patients with elevated pulmonary vascular resistance using echocardiography, cardiac MRI, cardiopulmonary exercise testing and brain natriuretic peptide levels. The hypothesis is that a group of morphologic and functional variables obtained noninvasively can differentiate an RV with VA coupling from that with VA uncoupling.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Observational Group | Subjects will undergo clinically indicated investigations and tests. The research part of the study is measuring the VA coupling using high fidelity catheters. That is expected to increase the duration of the cardiac catheterization for 30 minutes. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Measuring VA Coupling | Procedure | Subjects will undergo clinically indicated investigations and tests. The research part of the study is measuring the VA coupling using high fidelity catheters. That is expected to increase the duration of the cardiac catheterization for 30 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Identify echocardiographic measurements of right ventricular systolic function and pulmonary blood flow and their cutoff values contemporaneous that can identify VA uncoupling | Yes/No result: Can echocardiographic measurements allow non-invasive identification of VA uncoupling (defined as Ees/Ea <0.805). Three ratios: tricuspid annular plane systolic excursion to the pulmonary artery acceleration time, right ventricular free wall strain to the pulmonary artery acceleration time and, right ventricular fractional area change to the pulmonary artery acceleration time. | within one week of measurement of ventriculo-arterial coupling ratio during cardiac catheterization |
| Identify cMRI measurements of right ventricular systolic function and pulmonary blood flow and their cutoff values contemporaneous that can identify VA uncoupling. | Yes/No result: Can cMRI measurements allow non-invasive identification of VA uncoupling (defined as Ees/Ea <0.805). Two ratios: right ventricular ejection fraction to right ventricular end systolic volume and right ventricular ejection fraction to pulmonary artery acceleration time (by echocardiography). | within one week of measurement of ventriculo-arterial coupling ratio during cardiac catheterization |
| Identify 6-minute walk distance cutoff that can identify VA uncoupling | Yes/No: Can 6-minute walk distance identify VA uncoupling (defined as Ees/Es<0.805) | within one week of measurement of ventriculo-arterial coupling ratio during cardiac catheterization |
| Identify brain natriuretic peptide cutoff value that can identify VA uncoupling | Yes/No: Can brain natriuretic peptide identify VA uncoupling (defined as Ees/Es<0.805) | within one week of measurement of ventriculo-arterial coupling ratio during cardiac catheterization |
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Inclusion Criteria:
Exclusion Criteria:
claustrophobia, metal implants or allergy to contrast
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Children with Elevated Pulmonary Arterial Hypertension
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Brittany Faanes, MPH, CCRP | Contact | 612-625-5929 | grego318@umn.edu | |
| Jasmine Becerra, BS | Contact | 415-476-2649 | jasmine.becerra@ucsf.edu |
| Name | Affiliation | Role |
|---|---|---|
| Gurumurthy Hiremath, MD | University of Minnesota | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pediatric Pulmonary Hypertension Program | Recruiting | San Francisco | California | 94143 | United States |
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| University of Minnesota | Recruiting | Minneapolis | Minnesota | 55455 | United States |
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