Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

Abstract

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients

“…12 Other authors confirmed these results in both patients with HF and/or PH and cut-off values between 0.28 and 0.48 mm/mmHg have been identified as associated with prognosis. [11][12][13][14]18 Thus, our cut-off is in line with that previously identified in different populations.…”

“…The coupling between the function of the right ventricle and its afterload provides comprehensive information about right heart performance. The noninvasive TAPSE (tricuspid annular plane systolic excursion) over pulmonary artery systolic pressure (PASP) ratio, a surrogate of RV-PA coupling which correlated with invasive hemodynamic evaluation, 9,10 was found to be prognostically important in patients with heart failure 11–14 . However, limited evidence is available about the prognostic role of the TAPSE/PASP ratio in TAVI recipients 15,16 .…”

Bedside wireless lung ultrasound for the evaluation of COVID-19 lung injury in senior nursing home residents

“…Obviously, there are intrinsic limitations in a wireless system, as compared with other stand-alone machines with different probes, that have to be weighed in comparison with the necessity of portability in the nursing home setting. Echocardiography was not performed even though the assessment of right ventricular function would be valuable in older patients with COVID-19 pneumonia [25]. Finally, the reproducibility of the LUS technique was not evaluated in the study patients, even though reproducibility of transthoracic LUS has been previously fully explored [26].…”

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

“…Pulmonary arterial systolic pressure (PASP), as a Doppler index of RV afterload, is also easily acquired by echocardiography. TAPSE/PASP, as a method for the noninvasive measurement of RV-PA coupling, has gradually become an alternative parameter for Ees/Ea [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. It was shown that TAPSE/PASP was strongly correlated with the invasive assessment of RV-PA coupling [ 15 ].…”