Clinical significance of pulmonary arterial capacitance calculated by echocardiography in patients with advanced heart failure

Yuki Saito, Tomohito Ohtani, Hidetaka Kioka, Toshinari Onishi, Yasumasa Tsukamoto, Kei Nakamoto, Tatsunori Taniguchi, Satoshi Nakatani, Atsushi Hirayama, Yasushi Sakata

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8 Citations (Scopus)


Background: Advanced left heart failure (HF) often accompanies post-capillary pulmonary hypertension related to RV afterload. Although pulmonary arterial capacitance (PAC), a measure of pulmonary artery compliance, reflects right ventricular (RV) afterload, the clinical utility of PAC obtained by echocardiography (echo-PAC) is not well established in advanced HF. Methods and Results: We performed right heart catheterization in advanced HF patients (n=30), calculating echo-PAC as stroke volume/(tricuspid regurgitation pressure gradient-pulmonary regurgitation pressure gradient). The difference between the echo-PAC and catheter-measured PAC values was insignificant (0.21±0.17 mL/mmHg, P=0.23). Echo-PAC values predicted both pulmonary arterial wedge pressure (PAWP) ≥18 mmHg and pulmonary vascular resistance ≥3 Wood units (P=0.02, area under the curve: 0.88, cutoff value: 1.94 mL/mmHg). Next, we conducted an outcome study with advanced HF patients (n=72). Patients with echo-PAC <1.94 mL/mmHg had more advanced New York Heart Association functional class, higher B-type natriuretic peptide plasma levels, larger RV and lower RV fractional area change than those with echo-PAC ≥1.94 mL/mmHg. They also had a significantly higher rate of ventricular assist device implantation or death, even after adjustment for indices related to HF severity or RV function during a 1-year follow-up period (P<0.01). Conclusions: Decreased PAC as measured by echocardiography, indicating elevated PAWP and RV dysfunction, predicted poorer outcomes in patients with advanced HF.

Original languageEnglish
Pages (from-to)1871-1878
Number of pages8
JournalCirculation Journal
Issue number12
Publication statusPublished - 2017


  • Heart failure
  • Pulmonary hypertension
  • Right ventricular afterload


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