Echocardiographic Measure of Right Ventricular-Pulmonary Arterial Coupling Predicts Survival in Lung Cancer

Abstract

Rationale: Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in patients with lung cancer. Objectives: We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling. Methods: This prospective observational study included 220 outpatients with non-small cell lung cancer examined using Doppler, strain, and three-dimensional echocardiography before starting therapy. Of the included patients, 41% were women, and the median age was 68 years (interquartile range, 61-74 yr). Prediction of one-year overall survival was assessed using univariable analysis followed by multivariate Cox regression, receiver operating characteristic curves and Kaplan-Meier analyses. Results: Median sPAP was within the limits of normal (31 mm Hg [interquartile range, 26-36 mm Hg]); 30% of the patients had sPAP ≥ 35 mm Hg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS):sPAP ratio (hazard ratio [HR], 8.76 [95% confidence interval (CI), 1.24-61.82]; P = 0.03), forced expiratory volume in 1 second (HR, 0.98 [95% CI, 0.96-1.00]; P = 0.03) and Eastern Cooperative Oncology Group performance status <2 (HR, 0.34 [95% CI, 0.17-0.68]; P = 0.003) independently predicted survival. The optimal receiver operating characteristic curve-derived RV GLS:sPAP cutoff to predict survival was -0.54%/mm Hg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS:sPAP > -0.54%/mm Hg) had worse survival than those with maintained RV-arterial coupling (HR, 2.89 [95% CI, 1.55-5.42]; P < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR, 0.65 [95% CI, 0.35-1.20]; P = 0.17). Conclusions: RV GLS:sPAP ratio as an echocardiographic measure of RV-arterial coupling adds to prognostication by UICC status in non-small cell lung cancer. Clinical trial registered with www.clinicaltrials.gov (NCT04467333).

Keywords: echocardiography; non–small cell lung cancer; pulmonary hypertension; right ventricular global longitudinal strain.