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. 2021 Jul;38(7):1157-1164.
doi: 10.1111/echo.15096. Epub 2021 May 24.

Right ventricular-arterial coupling - A new perspective for right ventricle evaluation in heart failure patients undergoing cardiac resynchronization therapy

Silvia Deaconu  1   2 , Alexandru Deaconu  1   2 , Alina Scarlatescu  1   2 , Ioana Petre  1   2 , Sebastian Onciul  1   2 , Aura Vijiac  1   2 , Roxana Onut  2 , Diana Zamfir  2 , Gabriela Marascu  1 , Corneliu Iorgulescu  2 , Dan Andrei Radu  1   2 , Stefan Bogdan  1   2 , Radu Vatasescu  1   2 , Maria Dorobantu  1   2
Affiliations

Right ventricular-arterial coupling - A new perspective for right ventricle evaluation in heart failure patients undergoing cardiac resynchronization therapy

Silvia Deaconu et al. Echocardiography. 2021 Jul.

Abstract

Background: Right ventricular - arterial (RV-PA) coupling can be estimated by echocardiography using the ratio between (TAPSE) and pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio proved to be a prognostic parameter in patients with heart failure and reduced ejection fraction (HFrEF).

Objective: To evaluate the significance of RV-PA coupling in patients with HFrEF undergoing cardiac resynchronization therapy (CRT).

Methods: Patients undergoing CRT in our center between January 2017 and November 2019 were eligible. Response to CRT was defined by a reduction of more than 15% of left ventricle systolic volume (LVESV) one year after CRT. Primary endpoint was a composite of HF hospitalizations and death during follow-up.

Results: 54 patients (Age 64.0 ± 13.8 years; 58% male; left ventricular ejection fraction (LVEF) 28.4 ± 1.3%) were prospectively included. After a mean follow-up of 31 ± 12.9months, the primary endpoint had occurred in 18 (33.3%) patients. A lower TAPSE/PASP ratio was associated with baseline worse HF symptoms, lower LVEF and long-term less LV reverse remodeling (P < .05). After one year CRT improved RV systolic function (TAPSE, RV global longitudinal strain, P < .05), but not TAPSE/PASP ratio (P = .4). The ratio TAPSE/PASP (AUC=0.834) ≥ 0.58 mm/mm Hg showed good sensitivity (90%) and specificity (81.8%) for predicting response to CRT while a ratio <0.58 mm/mm Hg was associated with a higher risk of death and HF hospitalizations during the follow-up (HR 5.37 95%CI [1.6-18], P < .001).

Conclusion: RV-PA coupling evaluation using TAPSE/PASP ratio predicts CRT response. A lower TAPSE/PASP ratio is associated with a higher risk of adverse cardiovascular events.

Keywords: cardiac resynchronization therapy; heart failure; pulmonary circulation; right ventricular function; right ventricular-arterial coupling.

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References

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