Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 5;10(13):2995.
doi: 10.3390/jcm10132995.

Echocardiographic Assessment of Right Ventricular-Arterial Coupling in Predicting Prognosis of Pulmonary Arterial Hypertension Patients

Remigiusz Kazimierczyk  1 , Ewelina Kazimierczyk  1 , Malgorzata Knapp  1 , Bozena Sobkowicz  1 , Lukasz A Malek  2 , Piotr Blaszczak  3 , Katarzyna Ptaszynska-Kopczynska  1 , Ryszard Grzywna  3 , Karol A Kaminski  1   4
Affiliations

Echocardiographic Assessment of Right Ventricular-Arterial Coupling in Predicting Prognosis of Pulmonary Arterial Hypertension Patients

Remigiusz Kazimierczyk et al. J Clin Med. .

Abstract

In response to an increased afterload in pulmonary arterial hypertension (PAH), the right ventricle (RV) adapts by remodeling and increasing contractility. The idea of coupling refers to maintaining a relatively constant relationship between ventricular contractility and afterload. Twenty-eight stable PAH patients (mean age 49.5 ± 15.5 years) were enrolled into the study. The follow-up time of this study was 58 months, and the combined endpoint (CEP) was defined as death or clinical deterioration. We used echo TAPSE as a surrogate of RV contractility and estimated systolic pulmonary artery pressure (sPAP) reflecting RV afterload. Ventricular-arterial coupling was evaluated by the ratio between these two parameters (TAPSE/sPAP). In the PAH group, the mean pulmonary artery pressure (mPAP) was 47.29 ± 15.3 mmHg. The mean echo-estimated TAPSE/sPAP was 0.34 ± 0.19 mm/mmHg and was comparable in value and prognostic usefulness to the parameter derived from magnetic resonance and catheterization (ROC analysis). Patients who had CEP (n = 21) had a significantly higher mPAP (53.11 ± 17.11 mmHg vs. 34.86 ± 8.49 mmHg, p = 0.03) and lower TAPSE/sPAP (0.30 ± 0.21 vs. 0.43 ± 0.23, p = 0.04). Patients with a TAPSE/sPAP lower than 0.25 mm/mmHg had worse prognosis, with log-rank test p = 0.001. the echocardiographic estimation of TAPSE/sPAP offers an easy, reliable, non-invasive prognostic parameter for the comprehensive assessment of hemodynamic adaptation in PAH patients.

Keywords: coupling; echocardiography; prognosis; pulmonary arterial hypertension; right ventricle.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bland–Altman plot presenting differences between echo-derived TAPSE/sPAP and non-echo-derived TAPSE (MRI)/sPAP (RHC) ratios.
Figure 2
Figure 2
Spearman correlations between echo TAPSE/sPAP ratio and (A) mean pulmonary artery pressure, mPAP (r = −0.72, p < 0.001) and (B) right ventricle ejection fraction, RVEF (r = 0.51, p = 0.01).
Figure 3
Figure 3
Kaplan–Meier curves presenting deterioration-free survival in PAH patients based on TAPSE/sPAP ratio, log-rank test, p = 0.0004. °—complete events, +—censored events.
See this image and copyright information in PMC

References

    1. Galiè N., Hoeper M., Humbert M., Torbicki A., Vachiery J.-L., Barbera J.A., Beghetti M., Corris P., Gaine S.P., Gibbs J.S., et al. ESC Scientific Document Group. Guidelines for the diagnosis and treatment of pulmonary hypertension: The task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT) Eur. Heart J. 2016;37:67–119. - PubMed
    1. Noordegraaf A.V., Chin K., Haddad F., Hassoun P.M., Hemnes A.R., Hopkins S.R., Kawut S.M., Langleben D., Lumens J., Naeije R. Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: An update. Eur. Respir. 2019;53:1801900. doi: 10.1183/13993003.01900-2018. - DOI - PMC - PubMed
    1. Noordegraaf A.V., Westerhof B.E., Westerhof N. The relationship between the right ventricle and its load in pulmonary hypertension. J. Am. Coll. Cardiol. 2017;69:236–243. doi: 10.1016/j.jacc.2016.10.047. - DOI - PubMed
    1. Tello K., Dalmer A., Axmann J., Vanderpool R., Ghofrani A., Naeije R., Roller F., Seeger W., Sommer N., Wilhelm J., et al. Reserve of right ventricular-arterial coupling in the setting of chronic overload. Circ. Heart Fail. 2019;12:e005512. doi: 10.1161/CIRCHEARTFAILURE.118.005512. - DOI - PubMed
    1. Guazzi M., Bandera F., Pelissero G., Castelvecchio S., Menicanti L., Ghio S., Temporelli P.L., Arena R. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: An index of right ventricular contractile function and prognosis. Am. J. Physiol. Heart Circ. Physiol. 2013;305:H1373–H1381. doi: 10.1152/ajpheart.00157.2013. - DOI - PubMed

LinkOut - more resources