Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

Bragança, Bruno; Trêpa, Maria; Santos, Raquel B.; Silveira, Inês; Oliveira, Marta Fontes; Sousa, Maria João; Reis, Hipólito; Torres, Severo; Santos, Mário

doi:10.4250/jcvi.2019.0094

Cited by 25 publications

(18 citation statements)

References 43 publications

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“…A lower TAPSE/PASP was associated with a higher E/e ratio, and there was a significant difference in mean values of TAPSE/PASP among the diastolic dysfunction grades. A study of Bragança et al also reported that LV filling pressures, estimated by mitral E/e′ ratio, were higher in groups with lower TAPSE/PASP ratios 5 . In another study by Guazzi et al in patients with HF in the tertile with the lower TAPSE/PASP ratio (<0.35) there was a greater prevalence of severe diastolic dysfunction and a higher PASP and pulmonary capillary wedge pressure evaluated by invasive measurements 9 …”

Section: Discussionmentioning

confidence: 93%

“…The RV to pulmonary artery (RV‐PA) coupling refers to the relationship between RV contractility and RV afterload and may be affected in HF patients due to the increased LV filling pressures that lead to PH and increased RV afterload 5,6 . The gold standard for evaluation of RV‐PA coupling is obtained by invasive measures using pressure‐volume loop‐derived RV end‐systolic elastance/arterial elastance (Ees/Ea) 7 .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In our cohort, TAPSE/PASP was significantly lower in patients who presented adverse cardiovascular events at follow up. A study by Braganca et al, performed in HFrEF patients and CRT, found that TAPSE/PASP predicts response to CRT [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Ratio between Right Ventricular Longitudinal Strain and Pulmonary Arterial Systolic Pressure: Novel Prognostic Parameter in Patients Undergoing Cardiac Resynchronization Therapy

Deaconu

Scărlătescu

Petre

et al. 2021

JCM

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Background: We aimed to evaluate whether right ventricle (RV) longitudinal strain indexed to pulmonary arterial systolic pressure (PASP) has prognostic significance in patients undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT were prospectively included. The primary endpoint was adverse cardiovascular events (death and HF-related hospitalizations). RV global longitudinal strain (RVGLS) and RV free wall strain (RVfwS) were measured by speckle tracking and indexed to echocardiographic estimated PASP. Results: A total of 54 patients (64.0 ± 13.8 years; 58% male) were included. After 33 ± 12.9 months, the primary endpoint occurred in 18 patients. Baseline RVGLS/PASP and RVfwS/PASP showed good discriminative ability for response to CRT (AUC = 0.88, 95% CI (0.74–1) and AUC = 0.87, 95% CI (0.77–1)). RVGLS/PASP and RVfwS/PASP were significantly associated with high risk of events at univariate analysis (HR 0.039, 95% CI (0.001–0.8) p < 0.05, respectively HR = 0.049, 95% CI (0.0033–0.72), p < 0.05). Upon multivariate Cox regression analysis, RVGLS/PASP and RVfwS/PASP remained associated with high risk of events (HR 0.018, 95% CI (0.0005–0.64), p = 0.02 and HR 0.015, 95% CI (0.0004–0.524), p = 0.01) after correction for gender, etiology, QRS duration and morphology. Conclusions: Indexing RV longitudinal strain (global and free wall) by PASP provides a parameter, which independently identifies patients with high risk of cardiovascular events and predicts non-response to CRT.

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“…Uncoupling of the right ventricle-pulmonary artery, expressed as significantly lower TAPSE/PASP ratios, was also found. Recently, the association between TAPSE/PASP and the established markers of prognosis NT-pro BNP and E/e´ ratio were found in patients undergoing CRT 27 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of galectin-3 and right ventricular function for long-term mortality in heart failure patients treated with cardiac resynchronization therapy

Zaborska

Pilichowska-Paszkiet

Makowska

et al. 2021

Sci Rep

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Recently, associations between the biomarker galectin-3 and numerous pathological processes involved in heart failure (HF) and right ventricular (RV) function have been observed. We aimed to assess the long-term prognostic ability of galectin-3 and RV function parameters for all-cause mortality in HF patients treated with cardiac resynchronization therapy (CRT). We prospectively studied 63 symptomatic HF patients with a left ventricular (LV) ejection fraction (EF) ≤ 35%. The median serum galectin-3 concentration was 13.4 ng/mL (IQR 11.05, 17.15). A detailed assessment of LV and RV geometry and function was performed with echocardiography. CRT defibrillator implantation was achieved in all patients without major complications. The follow-up lasted 5 years. In the multivariable Cox regression model, independent predictors for all-cause mortality were log baseline galectin-3 and baseline RV function expressed as tricuspid annular plane systolic excursion with HR 2.96 (p = 0.037) and HR 0.88 (p = 0.023), respectively. Analysis of subgroups defined by galectin-3 concentration and CRT response showed that patients with high baseline galectin-3 concentrations and a lack of response to CRT had a significantly lower probability of survival. In our patient cohort, the baseline galectin-3 concentration and RV function were independent predictors of long-term all-cause mortality in HFrEF patients following CRT implantation.

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Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

Cited by 25 publications

References 43 publications

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

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

Ratio between Right Ventricular Longitudinal Strain and Pulmonary Arterial Systolic Pressure: Novel Prognostic Parameter in Patients Undergoing Cardiac Resynchronization Therapy

Prognostic value of galectin-3 and right ventricular function for long-term mortality in heart failure patients treated with cardiac resynchronization therapy

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