Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients

Iacoviello, Massimo; Monitillo, Francesco; Citarelli, Gaetano; Leone, Marta; Grande, Dario; Antoncecchi, Valeria; Rizzo, Caterina; Terlizzese, Paola; Romito, Roberta; Caldarola, Pasquale; Ciccone, Marco Matteo

doi:10.1016/j.ijcard.2017.04.051

Cited by 52 publications

(49 citation statements)

References 12 publications

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“…TAPSE/PASP is a clinically relevant and valid surrogate of invasively measured end‐systolic/arterial elastance ratio to assess RV‐to‐PC coupling. As shown in previous studies, TAPSE/PASP < 0.31 mm/mmHg predicted RV‐to‐PC uncoupling, which was associated with poor prognosis in patients with HF 14,33 . In this study, TAPSE/PASP was markedly decreased (0.27 mm/mmHg) at low‐load exercise in the low‐peak VO 2 group, suggesting RV‐to‐PC uncoupling was provoked during submaximal exercise in patients with exercise intolerance.…”

Section: Discussionsupporting

confidence: 80%

“…As shown in previous studies, TAPSE/PASP _x0003C; 0.31 mm/mmHg predicted RV-to-PC uncoupling, which was associated with poor prognosis in patients with HF. 14,33 In this study, TAPSE/PASP was markedly decreased (0.27 mm/mmHg) at low-load exercise in the Figure 2 Representative cases of a patient in the low-peak VO 2 group and a patient in the preserved-peak VO 2 group. (A) Representative case in a low-peak VO 2 group (peak VO 2 , 12.9 mL/kg/min).…”

Section: Discussionmentioning

confidence: 50%

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Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

et al. 2020

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Aims Traditional criteria for heart transplantation by cardiopulmonary exercise testing (CPX) include peak oxygen uptake (VO 2) < 14 mL/kg/min. Reaching a sufficient exercise load is challenging for patients with refractory heart failure (HF) because of their exercise intolerance. Recently, a substantial impact of right ventricular (RV) dysfunction was highlighted on urgent heart transplantation and mortality. This study aims to investigate the impact of RV contractile reserve, assessed by low-load exercise stress echocardiography (ESE), on exercise intolerance defined as peak VO 2 < 14 mL/kg/min, in patients with HF. Methods and results We prospectively examined 67 consecutive patients hospitalized for HF who underwent ESE and CPX under a stabilized HF condition. Although low-load ESE was defined as 25 W load exercise, an increment in RV systolic (s′) velocity was regarded as the preservation of RV contractile reserve. All patients completed low-load ESE. During low-load ESE, the variation in RV s′ velocity significantly correlated with peak VO 2 (r ¼ 0.787, P < 0.001). The change in RV s′ velocity during low-load ESE accurately identified patients with peak VO 2 < 14 mL/kg/min (area under the curve, 0.95; sensitivity, 92%; specificity, 85%). The intraclass correlation coefficient for intra-observer and inter-observer agreement for the change in RV s′ velocity was 0.96 (95% confidence interval, 0.88-0.99, P < 0.001) and 0.86 (95% confidence interval, 0.64-0.95, P < 0.001), respectively. The RV-to-pulmonary circulation (PC) coupling, which was assessed by the slope of the relationship between RV s′ velocity and pulmonary artery systolic pressure at rest and low-load exercise, was worse in the low-peak VO 2 group (<14 mL/kg/min) than the preserved-peak VO 2 group (≥14 mL/kg/min). Conclusions The change in RV s′ velocity during low-load ESE could estimate the exercise capacity in HF patients. The assessments of RV contractile reserve and RV-to-PC coupling could be clinically beneficial to distinguish high-risk HF patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 50%

Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

et al. 2020

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“…The gold standard in quantifying RV-PA coupling is the RV end-systolic elastance to the pulmonary arterial elastance ratio, measured invasively with multi-beat RV pressure-volume loop acquisitions by conducting a dedicated right heart catheterisation [ 26 , 27 ]. However, the routine use of this technique in clinical practice is not indicated, as it is invasive and requires specific conductance catheters.…”

Section: Discussionmentioning

confidence: 99%

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Masarone

Errigo

Melillo

et al. 2020

JCM

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Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.

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“…Therefore, the relationship between the RV contractility surrogate, assessed by two-dimensional strain, and the generated force expressed by PASP, could allow to better estimate the RV performance status. In a population of chronic HF patients, the combination of RV longitudinal strain (both RV-fwLS and RV-GLS) and estimated PASP provides a reliable index of RV-pulmonary arterial coupling and a parameter that is independently associated with an increased mortality risk and worse outcome [40].…”

Section: Echocardiographic Measures Of Right Ventriculo-arterial Uncomentioning

confidence: 99%

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Monitillo¹,

Terlizzi

Gioia

et al. 2020

JCDD

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There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.

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Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients

Cited by 52 publications

References 12 publications

Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

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