Pressure–volume loop validation of TAPSE/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension

Schmeißer, Alexander; Rauwolf, Thomas; Groscheck, Thomas; Kropf, Siegfried; Luani, Blerim; Tanev, Ivan; Hansen, Michael S.; Meissler, S; Steendijk, Paul; Braun‐Dullaeus, Ruediger C.

doi:10.1093/ehjci/jeaa285

Cited by 49 publications

(51 citation statements)

References 21 publications

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“…The left and right heart catheter measurements were carried out as described previously 16 . The forward cardiac output was calculated using the Fick method.…”

Section: Methodsmentioning

confidence: 99%

Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

et al. 2021

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Aims Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV-pulmonary artery (PA) coupling, is defined by the ratio of RV end-systolic to PA elastances (Ees/Ea). Using pressure-volume loop (PV-L) technique we aimed to identify an Ees/Ea cut-off predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to heart failure with reduced ejection fraction (HFREF). Methods and resultsThis post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography and a baseline PV-L and RV catheter measurement. A subgroup of patients (n = 50) without a pre-implanted cardiac device underwent magnetic resonance imaging at baseline. The analysis revealed that 0.68 is an optimal Ees/Ea cut-off (area under the curve: 0.697, P < 0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥ 0.68 vs. <0.68, log-rank 8.9, P = 0.003). In patients with PH (n = 76, 68%) multivariate Cox regression demonstrated the independent prognostic value of RV-Ees/Ea in PH patients (hazard ratio 0.2, P < 0.038). Patients without PH (n = 36, 32%) and those with PH but RV-Ees/Ea ≥ 0.68 showed comparable RV-Ees/Ea ratios (0.88 vs. 0.9, P = 0.39), RV size/function, and survival. In contrast, secondary PH with RV-PA coupling ratio Ees/Ea < 0.68 corresponded extremely close to cut-off values that define RV dilatation/remodelling (RV end-diastolic volume >160 mL, RV-mass/volume-ratio ≤0.37 g/mL) and dysfunction (right ventricular ejection fraction <38%, tricuspid annular plane systolic excursion <16 mm, fractional area change <42%, and stroke-volume/end-systolic volume ratio <0.59) and is associated with a dramatically increased short and medium-term all-cause mortality. Independent predictors of prognostically unfavourable RV-PA coupling (Ees/Ea < 0.68) in secondary PH were a pre-existent dilated RV [end-diastolic volume >171 mL, odds ratio (OR) 0.96, P = 0.021], high pulsatile load (PA compliance <2.3 mL/mmHg, OR 8.6, P = 0.003), and advanced systolic left heart failure (left ventricular ejection fraction <30%, OR 1.23, P = 0.028). Conclusions The RV-PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodelling, and left ventricular dysfunction. Prognostically favourable coupling (RV-Ees/Ea ≥ 0.68) in PH was associated with preserved RV size/function and mid-term survival, comparable with HFREF without PH.

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“…The left and right heart catheter measurements were carried out as described previously 16 . The forward cardiac output was calculated using the Fick method.…”

Section: Methodsmentioning

confidence: 99%

Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

et al. 2021

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“…Measuring Ees/Ea in pressure-volume loops as a surrogate for RV-PA coupling is the current, invasive gold standard for the assessment of the RV function in relation to pulmonary afterload and the transition to right heart failure [ 8 ]. TAPSE/PASP correlates well with Ees/Ea in patients with HFpEF [ 16 ] and HFrEF [ 28 ]. It was also associated with higher mortality in HFpEF and in HFrEF patients [ 14 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…TAPSE/PASP correlates well with Ees/Ea in patients with HFpEF [ 16 ] and HFrEF [ 28 ]. It was also associated with higher mortality in HFpEF and in HFrEF patients [ 14 , 28 , 29 ]. Studies in patients with PH also showed an independent association of TAPSE/PASP with Ees/Ea, suggesting that TAPSE/PASP could be a non-invasive parameter of RV-PA coupling [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Application and Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio in Patients with Ischemic and Non-Ischemic Cardiomyopathy

et al. 2021

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The main aim of this study was to assess the prognostic utility of TAPSE/PASP as an echocardiographic parameter of maladaptive RV remodeling in cardiomyopathy patients using cardiac magnetic resonance (CMR) imaging. Furthermore, we sought to compare TAPSE/PASP to TAPSE. The association of the echocardiographic parameters TAPSE/PASP and TAPSE with CMR parameters of RV and LV remodeling was evaluated in 111 patients with ischemic and non-ischemic cardiomyopathy and cut-off values for maladaptive RV remodeling were defined. In a second step, the prognostic value of TAPSE/PASP and its cut-off value were analyzed regarding mortality in a validation cohort consisting of 221 patients with ischemic and non-ischemic cardiomyopathy. A low TAPSE/PASP (<0.38 mm/mmHg) and TAPSE (<16 mm) were associated with a lower RVEF and a long-axis RV global longitudinal strain (GLS) as well as higher RVESVI, RVEDVI and NT-proBNP. A low TAPSE/PASP, but not TAPSE, was associated with a lower LVEF and long-axis LV GLS, and a higher LVESVI, LVEDVI and T1 relaxation time at the interventricular septum and the RV insertion points. Furthermore, in the validation cohort, low TAPSE/PASP was associated with a higher mortality and TAPSE/PASP was an independent predictor of mortality. TAPSE/PASP is a predictor of maladaptive RV and LV remodeling associated with poor outcomes in cardiomyopathy patients.

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“…Due to its technical complexity, the assessment of RVPAC is not routinely performed. However, non-invasive estimation of RVPAC can be done using cardiac magnetic resonance (CMR) [7] or transthoracic echocardiography [8], and non-invasive parameters showed good correlation with catheterisation-derived measurements [7][8][9][10]. Three-dimensional (3D) echocardiography overcomes the pitfalls of conventional RV functional assessment [11] and has been validated against CMR [12].…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

Vijiiac

Onciul

Vătăşescu

et al. 2021

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Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.

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Pressure–volume loop validation of TAPSE/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension

Cited by 49 publications

References 21 publications

Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

Predictors and prognosis of right ventricular function in pulmonary hypertension due to heart failure with reduced ejection fraction

Application and Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio in Patients with Ischemic and Non-Ischemic Cardiomyopathy

Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

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