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

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.

Right ventricular–pulmonary artery coupling in cardiac resynchronization therapy: evolution and prognosis

“…In a study of 54 CRT recipients, Deaconu et al . demonstrated that the TAPSE/PASP ratio was linked to both CRT response (defined as ≥15% reduction in LV end‐systolic volume) as well as cardiovascular events 23 . Using a different definition (≥5% improvement in LVEF), Bragança et al .…”

“…In a study of 54 CRT recipients, Deaconu et al demonstrated that the TAPSE/PASP ratio was linked to both CRT response (defined as ≥15% reduction in LV end-systolic volume) as well as cardiovascular events. 23 Using a different definition (≥5% improvement in LVEF), Bragança et al also found the TAPSE/PASP ratio to be associated with CRT response. 24 The current study expands on these results by demonstrating a strong, independent link between the TAPSE/PASP ratio and long-term outcome in a large, unselected cohort of CRT recipients.…”

Application of an echocardiographic index to characterize right ventricular–pulmonary arterial coupling in heart failure

“…74 Several recent studies show that the TAPSE/PASP ratio can serve as a predictive tool to assess a patient's potential response to CRT. 38,75 Low TAPSE/PASP was associated with a greater likelihood of cardiac events and an inferior response to CRT. 76 TAPSE/PASP gives considerable clinical utility to overtime surveillance of patients with HFrEF after CRT.…”

“…Patients with HFrEF can benefit from cardiac resynchronization therapy (CRT) 74 . Several recent studies show that the TAPSE/PASP ratio can serve as a predictive tool to assess a patient's potential response to CRT 38,75 . Low TAPSE/PASP was associated with a greater likelihood of cardiac events and an inferior response to CRT 76 .…”

Clinical Usefulness of Right Ventricle–Pulmonary Artery Coupling in Cardiovascular Disease

“…In a cohort of 54 patients with HfrEF undergoing cardiac resynchronization therapy, it was demonstrated that TAPSE/PASP displayed good sensitivity (90%) and specificity (81.8%) for predicting the response to cardiac resynchronization therapy. Moreover, a lower TAPSE/PASP ratio was associated with a higher incidence of adverse cardiovascular events during the follow-up [ 94 ]. Hence, these findings suggested that the TAPSE/PASP ratio may become a standard echocardiographic evaluation parameter for HfrEF patients undergoing cardiac resynchronization therapy.…”