Right Side of the Heart Pulmonary Circulation Unit Involvement in Left-Sided Heart Failure

Marra, Alberto M.; Sherman, Alexander E.; Salzano, Andrea; Guazzi, Marco; Saggar, Rajan; Squire, IB; Cittadini, Antonio; Channick, Richard N.; Bossone, Eduardo

doi:10.1016/j.chest.2021.09.023

Cited by 11 publications

(5 citation statements)

References 86 publications

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“…Univariable and multivariable Cox regression analyses were performed to estimate the prognostic value of the RV-PA coupling surrogates. For the baseline adjustment model in the multivariable analysis, we selected age, left atrial (LA) volume index, and left ventricular ejection fraction (LVEF) as potential confounding risk factors of HF 23,24 that were also significant in the univariable analysis. Then, several multivariable models were constructed by adding the RV-PA coupling surrogates, RV function parameters, or PASP to the baseline model.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic value among echocardiographic surrogates of right ventricular–pulmonary arterial coupling: A three‐dimensional echocardiographic study

Kuwajima,

Ogawa,

Ruiz

et al. 2023

Echocardiography

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ObjectivesRight ventricular (RV)–pulmonary arterial (PA) coupling is important in various cardiac diseases. Recently, several echocardiographic surrogates for RV–PA coupling have been proposed and reported to be useful in predicting outcomes. However, it remains unclear which surrogate is the most clinically relevant. This study aimed to comprehensively compare the prognostic value of different echocardiographic RV–PA coupling surrogates.MethodsWe retrospectively reviewed 242 patients with various cardiac conditions who underwent comprehensive transthoracic echocardiography with three‐dimensional RV data. In addition to conventional parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and PA systolic pressure (PASP), we analyzed RV free wall and global longitudinal strain (FWLS and GLS). We also obtained RV ejection fraction (RVEF), stroke volume (SV), and end‐systolic volume (ESV) using three‐dimensional RV analysis. RV–PA coupling surrogates were calculated as TAPSE/PASP, FAC/PASP, FWLS/PASP, GLS/PASP, RVEF/PASP, and SV/ESV. The study endpoint was a composite outcome of all‐cause death or cardiovascular hospitalization within 1 year.ResultsIn multivariable analysis, all the RV–PA coupling surrogates were independent predictors of the outcome. Among the surrogates, the model with TAPSE/PASP showed the lowest prognostic value in model fit and discrimination ability, whereas the model with RVEF/PASP exhibited the highest prognostic value. The partial likelihood ratio test indicated that the model with RVEF/PASP was significantly better than the model with TAPSE/PASP (p < .024).ConclusionAll the RV–PA coupling surrogates were independent predictors of the outcome. Notably, RVEF/PASP had the highest prognostic value among the surrogates.

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Section: Discussionmentioning

confidence: 99%

Comparison of prognostic value among echocardiographic surrogates of right ventricular–pulmonary arterial coupling: A three‐dimensional echocardiographic study

Kuwajima,

Ogawa,

Ruiz

et al. 2023

Echocardiography

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“…There are multiple mechanisms involved in the development of hypertension from HFpEF, and these mechanisms can be divided into several categories. The most common is microcirculatory dysfunction, which mainly includes an increase in inflammatory factors, the occurrence of oxidative stress, impaired endothelial function, and the occurrence of vascular endothelial fibrosis (Gryglewska et al, 2011;Paulus and Tschöpe, 2013;Stupin et al, 2021;Marra et al, 2022).…”

Section: Relationship Between Microcirculation-induced Hypertension A...mentioning

confidence: 99%

Microvascular rarefaction caused by the NOTCH signaling pathway is a key cause of TKI-apatinib-induced hypertension and cardiac damage

Wang,

Li,

et al. 2024

Front. Pharmacol.

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With the advancement of tumour-targeted therapy technology, the survival of cancer patients has continued to increase, and cardiovascular events have gradually become an important cause of death in cancer patients. This phenomenon occurs due to adverse cardiovascular reactions caused by the cardiovascular toxicity of antitumour therapy. Moreover, the increase in the proportion of elderly patients with cancer and cardiovascular diseases is due to the extension of life expectancy. Hypertension is the most common cardiovascular side effect of small molecule tyrosine kinase inhibitors (TKIs). The increase in blood pressure induced by TKIs and subsequent cardiovascular complications and events affect the survival and quality of life of patients and partly offset the benefits of antitumour therapy. Many studies have confirmed that in the pathogenesis of hypertension, arterioles and capillary thinness are involved in its occurrence and development. Our previous findings showing that apatinib causes microcirculation rarefaction of the superior mesenteric artery and impaired microvascular growth may inspire new therapeutic strategies for treating hypertension. Thus, by restoring microvascular development and branching patterns, total peripheral resistance and blood pressure are reduced. Therefore, exploring the key molecular targets of TKIs that inhibit the expression of angiogenic factors and elucidating the specific molecular mechanism involved are key scientific avenues for effectively promoting endothelial cell angiogenesis and achieving accurate repair of microcirculation injury in hypertension patients.

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“…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 ].…”

Section: Measurement Of Right Ventricular–pulmonary Artery Couplingmentioning

confidence: 99%

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

Zhu

Gao

et al. 2023

JCM

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Right ventricular–pulmonary artery coupling (RV-PA coupling) refers to the relationship between RV contractility and RV afterload. Normal RV-PA coupling is maintained only when RV function and pulmonary vascular resistance are appropriately matched. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure. RV-PA coupling plays an important role in the pathophysiology and progression of cardiovascular diseases. Therefore, early and accurate evaluation of RV-PA coupling is of great significance for a patient’s condition assessment, clinical decision making, risk stratification, and prognosis judgment. RV-PA coupling can be assessed by using invasive or noninvasive approaches. The aim of this review was to summarize the pathological mechanism and evaluation methods of RV-PA coupling, the advantages and disadvantages of each method, and the application value of RV-PA coupling in various cardiovascular diseases.

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Right Side of the Heart Pulmonary Circulation Unit Involvement in Left-Sided Heart Failure

Cited by 11 publications

References 86 publications

Comparison of prognostic value among echocardiographic surrogates of right ventricular–pulmonary arterial coupling: A three‐dimensional echocardiographic study

Comparison of prognostic value among echocardiographic surrogates of right ventricular–pulmonary arterial coupling: A three‐dimensional echocardiographic study

Microvascular rarefaction caused by the NOTCH signaling pathway is a key cause of TKI-apatinib-induced hypertension and cardiac damage

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

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