Prognostic implication of noninvasive right ventricle-to-pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

Abstract

Aims: Impairment of right ventricle-to-pulmonary artery coupling (RV-PA coupling) is a major determinant of poor prognosis in patients with pulmonary hypertension. This study sought to evaluate the ability of an echo-derived metric of RV-PA coupling, the ratio between tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery systolic pressure (PASP) and to predict adverse clinical outcomes in chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results: A total of 205 consecutive patients with confirmed CTEPH were retrospectively recruited from Fuwai Hospital between February 2016 and November 2020. Baseline echocardiography, right heart catheterization, and cardiopulmonary exercise testing were analyzed. Patients with lower TAPSE/PASP had a significantly compromised echocardiographic and hemodynamic status and exercise capacity at baseline. The TAPSE/PASP ratio correlated significantly with hemodynamic parameters, including pulmonary vascular resistance ( r = −0.48, p < 0.001) and pulmonary arterial compliance ( r = 0.45, p < 0.001). During a median period of 1-year follow-up, 63 (30.7%) patients experienced clinical worsening. The relationship between TAPSE/PASP and clinical worsening was assessed using different multivariate Cox regression models. After adjustment for a series of previously screened independent predictors, TAPSE/PASP remained significantly associated with outcomes, and the hazard ratio (per standard deviation increase) of the final model was 0.402. Conclusion: In patients with CTEPH, baseline RV-PA coupling measured as the TAPSE/PASP ratio is associated with disease severity and adverse outcomes. A low TAPSE/PASP identifies patients with a high risk of clinical deterioration, and this novel metric could be applicable for risk stratification in CTEPH.

Effect of Obstructive Sleep Apnea on Right Ventricle Contractile Function and its Coupling to Pulmonary Circulation in Hypertensive Patients using Cardiovascular Magnetic Resonance Imaging

“…which are strong predictors of adverse outcomes in PH (19). According to our results, RV function showed signi cant negative correlation with AHI and the RV-PA Coupling by Ees/Ea calculation.Tello et al (18) proved that the coupling of RV-PA has considerable reserve, as Ees/Ea has to decrease from normal values of 1.5 to 2 to < 0.8 before RV maladaptation…”

“…Duan, X Li et al 2022 evaluate the ability of an echocardiography derived RV-PA coupling using TAPSE/ PASP ratio to predict adverse clinical outcomes in chronic thromboembolic pulmonary hypertension (CTEPH) and concluded that low TAPSE/PASP identi es patients with a high risk of clinical deterioration, and this novel metric could be applicable for risk strati cation in CTEPH, the study also proved that the TAPSE/PASP ratio was signi cantly related to PVR and Pulmonary arterial compliance,…”

Advantages of three-dimensional echocardiography over TAPSE/sPAP for the assessment of right ventricular–arterial coupling in precapillary pulmonary hypertension

“…Nevertheless, the TAPSE/sPAP has been shown to be associated with clinical deterioration, hemodynamics, functional class, disease severity and adverse outcomes [21,22] . It was also found that the TAPSE/sPAP could be applicable for risk strati cation in CTEPH patients [21] .…”

“…Nevertheless, the TAPSE/sPAP has been shown to be associated with clinical deterioration, hemodynamics, functional class, disease severity and adverse outcomes [21,22] . It was also found that the TAPSE/sPAP could be applicable for risk strati cation in CTEPH patients [21] . Our results further demonstrated that the TAPSE/sPAP could be an independent predictor of prognostic risk strati cation for precapillary PH patients.…”

The potential of cystatin C as a predictive biomarker in pulmonary hypertension

“…All patients underwent standard transthoracic echocardiography conducted by experienced cardiologists as previously detailed [ 14 ]. The left ventricular ejection fraction was calculated using the Simpson biplane method.…”