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

Deaconu, Alexandru; Scărlătescu, Alina; Petre, Ioana; Onciul, Sebastian; Vijiiac, A E; Zamfir, Diana; Marascu, Gabriela; Iorgulescu, Corneliu; Radu, Andra-Victoria; Богдан, Стефан; Vătăşescu, Radu

doi:10.3390/jcm10112442

Cited by 7 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…RVFWLS/PASP and RVGLS/PASP predicted cardiac resynchronization therapy (CRT) response and adverse events after CRT in HF with reduced EF (HFrEF) (sensitivity 80% and specificity 77% for both). 39 In 315 stable outpatients with chronic HF (LVEF < 45%), RVFWLS/PASP and RVGLS/PASP appeared superior to TAPSE/PASP in predicting mortality. 40 In patients with HFrEF treated with sacubitril/valsartan, improvement in RV–PA coupling, indicated by TAPSE/PASP, was accompanied by improvement of right‐ and left‐sided cardiac parameters over 12 and 24 month follow‐up periods.…”

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 92%

“…Ever since TAPSE/PASP was introduced as a prognostic factor in HF, non‐invasive surrogate measures of RV–PA coupling have been extensively evaluated in many left‐sided cardiac pathologies. RVFWLS/PASP and RVGLS/PASP predicted cardiac resynchronization therapy (CRT) response and adverse events after CRT in HF with reduced EF (HFrEF) (sensitivity 80% and specificity 77% for both) 39 . In 315 stable outpatients with chronic HF (LVEF < 45%), RVFWLS/PASP and RVGLS/PASP appeared superior to TAPSE/PASP in predicting mortality 40 .…”

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 99%

See 1 more Smart Citation

Adaptive versus maladaptive right ventricular remodelling

et al. 2022

View full text Add to dashboard Cite

Right ventricular (RV) function and its adaptation to increased afterload [RV–pulmonary arterial (PA) coupling] are crucial in various types of pulmonary hypertension, determining symptomatology and outcome. In the course of disease progression and increasing afterload, the right ventricle undergoes adaptive remodelling to maintain right‐sided cardiac output by increasing contractility. Exhaustion of compensatory RV remodelling (RV–PA uncoupling) finally leads to maladaptation and increase of cardiac volumes, resulting in heart failure. The gold‐standard measurement of RV–PA coupling is the ratio of contractility [end‐systolic elastance (Ees)] to afterload [arterial elastance (Ea)] derived from RV pressure–volume loops obtained by conductance catheterization. The optimal Ees/Ea ratio is between 1.5 and 2.0. RV–PA coupling in pulmonary hypertension has considerable reserve; the Ees/Ea threshold at which uncoupling occurs is estimated to be ~0.7. As RV conductance catheterization is invasive, complex, and not widely available, multiple non‐invasive echocardiographic surrogates for Ees/Ea have been investigated. One of the first described and best validated surrogates is the ratio of tricuspid annular plane systolic excursion to estimated pulmonary arterial systolic pressure (TAPSE/PASP), which has shown prognostic relevance in left‐sided heart failure and precapillary pulmonary hypertension. Other RV–PA coupling surrogates have been formed by replacing TAPSE with different echocardiographic measures of RV contractility, such as peak systolic tissue velocity of the lateral tricuspid annulus (S′), RV fractional area change, speckle tracking‐based RV free wall longitudinal strain and global longitudinal strain, and three‐dimensional RV ejection fraction. PASP‐independent surrogates have also been studied, including the ratios S′/RV end‐systolic area index, RV area change/RV end‐systolic area, and stroke volume/end‐systolic volume. Limitations of these non‐invasive surrogates include the influence of severe tricuspid regurgitation (which can cause distortion of longitudinal measurements and underestimation of PASP) and the angle dependence of TAPSE and PASP. Detection of early RV remodelling may require isolated analysis of single components of RV shortening along the radial and anteroposterior axes as well as the longitudinal axis. Multiple non‐invasive methods may need to be applied depending on the level of RV dysfunction. This review explains the mechanisms of RV (mal)adaptation to its load, describes the invasive assessment of RV–PA coupling, and provides an overview of studies of non‐invasive surrogate parameters, highlighting recently published works in this field. Further large‐scale prospective studies including gold‐standard validation are needed, as most studies to date had a retrospective, single‐centre design with a small number of participants, and validation against gold‐standard Ees/Ea was rarely performed.

show abstract

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 92%

Section: Non‐invasive Surrogates Of Right Ventricular–pulmonary Arter...mentioning

confidence: 99%

Adaptive versus maladaptive right ventricular remodelling

et al. 2022

View full text Add to dashboard Cite

show abstract

“…RV-to-arterial coupling was estimated as the ratio between TAPSE or RV GLS and sPAP. Cut-off values ≤0.31 mm/mmHg or ≤0.35%/mmHg, respectively, were used to define RV uncoupling, as previously described [ 5 , 22 ]. Left chamber (size and function) quantification was assessed as previously described [ 17 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases

Santoro

Buonauro

Canora

et al. 2022

JCM

View full text Add to dashboard Cite

Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p < 0.0001). Patients with an RV GLS/sPAP below the median value had a shorter survival time (61 vs. 74 months, p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications.

show abstract

“…Besides TAPSE, tricuspid annular lateral wall peak systolic velocity (S′), RV fractional area change, RV ejection fraction (RVEF), RV global longitudinal strain, and RV free wall strain are echocardiographic parameters used to evaluate RV systolic function, and their ratio to PASP could similarly symbolize RV–PA coupling 33,38–42 . TAPSE/PASP was the sole non‐invasive marker of RV–PA coupling that independently correlated with Ees/Ea determined using invasive methods 19,39,43,44 ; therefore, it has great potential and is already frequently used in clinical settings 24,45–50 .…”

Section: Assessment Of Right Ventricular–pulmonary Arterial Couplingmentioning

confidence: 99%

“…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 .…”

Section: Tricuspid Annular Plane Systolic Excursion/pulmonary Artery ...mentioning

confidence: 99%

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

Chen,

Zhang,

Lou

et al. 2024

ESC Heart Failure

View full text Add to dashboard Cite

Heart failure (HF), with its high morbidity and mortality, remains a global public health issue. Right ventricular (RV) dysfunction is a sign of deterioration in the natural history of HF, and a thorough evaluation of the relationship between RV contractility and its afterload through RV–pulmonary arterial (RV–PA) coupling can aid in accurately assessing overall RV function. The ratio of RV end‐systolic elastance (Ees) to pulmonary arterial elastance (Ea) invasively measured by right heart catheterization served as the gold standard for evaluating RV–PA coupling. An echocardiographic index termed tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) has been shown to correlate well with Ees/Ea. TAPSE/PASP is recognized as a non‐invasive surrogate of RV–PA coupling and has been extensively studied in patients with HF. This review briefly describes the methods of assessing RV–PA coupling, mainly discussing echocardiography, summarizes the clinical utility of TAPSE/PASP in patients with different HF types, and provides an overview of the available literature.

show abstract

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

Cited by 7 publications

References 20 publications

Adaptive versus maladaptive right ventricular remodelling

Adaptive versus maladaptive right ventricular remodelling

Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases

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

Contact Info

Product

Resources

About