Rv pa coupling in patient with MR000ppp0

Presentation

1. بسم الله الرحمن الرحيم (ربنا افتح بيننا و بين قومنا بالحق وأنت خير الفاتحين) صدق الله العظيم سورة الأعراف الآية: 89

2. " Right ventricle and pulmonary artery coupling in patient with mitral regurgitation. “ By Dr/ Ramadan Muhammad Kamal Hamed Resident of Cardiology Faculty of medicine Al-Azhar University, C airo 2025

3. Introduction

4. Mitral regurgitation (MR) occurs when blood flows backwards from the left ventricle (LV) into the left atrium. It is a common heart valve disease that can lead to serious health issues. While most treatments focus on the left side of the heart, there is growing evidence that right ventricular (RV) dysfunction and its connection to the pulmonary system are important factors in understanding MR outcomes . Right ventricular–pulmonary artery (RV-PA) coupling refers to the relationship between RV contractility and RV afterload. Normal RV-PA coupling is only maintained when RV function and pulmonary vascular resistance are appropriately matched. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure. RV-PA coupling plays an important role in the pathophysiology and progression of cardiovascular diseases. Therefore, an early and accurate evaluation of RV-PA coupling is highly significant for assessing a patient’s condition, informing clinical decisions, stratifying risk and judging prognosis. RV-PA coupling can be assessed using either invasive or non-invasive approaches .

5. This review aimed to summarize the pathological mechanisms and evaluation methods of RV-PA coupling, the advantages and disadvantages of each method, and the application value of RV-PA coupling in mitral regurgitation . RV-PA coupling is a comprehensive index requiring an overall understanding of RV function and RV afterload and can be evaluated using integrated haemodynamic parameters related to RV function and afterload. RV-PA coupling is influenced by RV function; however, achieving a good assessment of RV function is very challenging . RV-PA coupling can be measured using invasive or non-invasive methods. Invasive measurement involves right heart catheterization (RHC), while non-invasive methods include echocardiography and cardiac magnetic resonance (CMR) imaging. Chronic volume overload in MR leads to progressive left atrial enlargement and increased pulmonary venous pressures, which in turn elevate pulmonary arterial pressures and RV afterload. When RV contractile reserve fails to match this afterload, RV–PA uncoupling occurs, heralding adverse outcomes.

6. Aim of the study

7. This study aims to evaluate the prognostic significance of right ventricle–pulmonary artery (RV–PA) coupling in patients with Rheumatic mitral regurgitation (MR) grades from a cardiovascular medicine standpoint, using primarily noninvasive echocardiographic indices such as the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP) and RV free-wall strain/PASP

8. Patients and methods

9. Type of study : Prospective, observational cohort study. Study setting : consecutive patients with Rheumatic MR referred to cardiology for evaluation/treatment (medical, surgical, or transcatheter). Study population and data collection : A total of sixty adult patients diagnosed with Rheumatic mitral regurgitation (mild, moderate and severe) will be recruited for the study. Patients will undergo a comprehensive transthoracic echocardiogram (TTE) at baseline.

10. Inclusion criteria

11. Age ≥ 18 years . Echocardiographically confirmed Rheumatic mitral regurgitation (according to current ASE/EACVI criteria) . Referral for any of conservative management, evaluation for mitral intervention (surgical or transcatheter), or diagnostic work-up . Able to consent and comply with follow-up . Adequate echocardiographic image quality. Sinus rhythm.

12. Exclusion criteria

13. Primary severe pulmonary arterial hypertension unrelated to left heart disease ( mPAP ≥ 25 mmHg with PCWP normal and known PAH). Prior right ventricular (RV) infarction within 3 months. Concomitant severe aortic valve disease requiring immediate surgery. End-stage non-cardiac disease with life expectancy < 1 year (e.g., advanced malignancy). Inability to obtain adequate echocardiographic windows. Previous mitral valve surgery. Congenital heart disease (except for mitral valve prolapse). Secondary or functional Mitral Regurgitation

14. Methodology

15. Everyone in this study will be subjected to the following

16. History: A proper history will be taken and documented including: age, sex, occupation, previous medical and surgical history 2) Examination: General inspection (edema, dyspnea, fatigue, Heart failure signs) Jugular venous pulse Precordial inspection and palpation Auscultation by stethoscope for heart sounds and murmurs 3) Investigations: By Echocardiogram (to assess degree of Mitral regurge , RV function and PA pressure in different degrees of MR

17. Thank you