Novel Echocardiographic Measurements of Right Ventricular–Pulmonary Artery Coupling in Predicting the Prognosis of Precapillary Pulmonary Hypertension

Abstract

Background: Currently, there are many parameters with proven prognostic significance in pulmonary hypertension (PH). Recently, the parameters defining right ventricular–pulmonary artery coupling (RVPAC) have gained clinical importance. In our study, we investigated the prognostic potential of previously known single echocardiographic parameters and new parameters reflecting RVPAC in patients with precapillary PH. Objective: Our study aimed to evaluate the prognostic value of selected echocardiographic parameters and the neutrophil–lymphocyte ratio (NLR) in adults with precapillary PH. Methods: This study included 39 patients (74% women; average age, 63 years) with precapillary PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). The mean follow-up period was 16.6 ± 13.3 months. Twelve patients (31%) died during the observation time. We measured several echocardiographic parameters, which reflect right ventricular function, pulmonary hemodynamics, and RVPAC. To assess disease progression and the patient’s functional capacity, the World Health Organization functional class (WHO FC) was determined. The patient’s physical capacity was also evaluated using the 6 min walk test (6MWT). The analysis included values of the N-terminal prohormone brain natriuretic peptide (NT-proBNP) and NLR. Results: TAPSE × AcT and TAPSE/sPAP were shown to statistically and significantly correlate with PH predictors, including WHO-FC, 6MWT, and NT-proBNP. Univariate Cox proportional hazards regression analysis revealed that AcT, TAPSE, mPAP, TAPSE/sPAP, RAP, TRPG/AcT, TAPSE × AcT, and NLRs are good predictors of mortality in patients with PH. In addition, the ROC curve analysis showed that TAPSE × AcT is a better predictor of PH-related deaths than TAPSE/sPAP and TAPSE alone. In our study, patients with TAPSE × AcT values < 126.36 had shorter survival times (sensitivity = 72.7%; specificity = 80.0%). Conclusions: TAPSE × AcT is a novel, promising, and practicable echocardiographic parameter reflecting RVPAC, which is comparable to TAPSE/sPAP. Moreover, TAPSE × AcT can be a useful parameter in assessing the severity and prognosis of patients with precapillary PH.

The value of right ventricular pulmonary artery coupling in determining the prognosis of patients with sepsis

“…The results revealed that the predictive AUC of the nomogram was 0.878 (95% CI 0.809–0.948), surpassing the predictive efficacy of individual indicators, including SOFA score and Apache II score (DeLong test, p < 0.05). RV-PA uncoupling leads to the disturbance of cardiopulmonary interactions, exacerbates right ventricular dysfunction, decreases cardiac output and oxygen content, and may cause tissue hypoperfusion of small capillaries 28 . On the other hand, inflammatory factors in sepsis, such as IL-6 and lactate, act on blood vessels, triggering the formation of thrombi and constriction of small blood vessels in sepsis.…”