Right ventricular‐arterial coupling – A new perspective for right ventricle evaluation in heart failure patients undergoing cardiac resynchronization therapy. Issue 7 (24th May 2021)

• Record Type: Journal Article
• Authors: Deaconu, Silvia; Deaconu, Alexandru; Scarlatescu, Alina; Petre, Ioana; Onciul, Sebastian; Vijiac, Aura; Onut, Roxana; Zamfir, Diana; Marascu, Gabriela; Iorgulescu, Corneliu; Radu, Dan Andrei; Bogdan, Stefan; Vatasescu, Radu; Dorobantu, Maria
• Is Part Of: Echocardiography. Volume 38:Issue 7(2021)
• Page Start: 1157
• Page End: 1164
• Publication Date: 2021-05-24
• Subjects: right ventricular function -- cardiac resynchronization therapy -- heart failure -- right ventricular‐arterial coupling -- pulmonary circulation; Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.15096
• Languages: English
• ISSNs: 0742-2822

Abstract

Abstract: Background: Right ventricular – arterial (RV‐PA) coupling can be estimated by echocardiography using the ratio between (TAPSE) and pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio proved to be a prognostic parameter in patients with heart failure and reduced ejection fraction (HFrEF). Objective: To evaluate the significance of RV‐PA coupling in patients with HFrEF undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT in our center between January 2017 and November 2019 were eligible. Response to CRT was defined by a reduction of more than 15% of left ventricle systolic volume (LVESV) one year after CRT. Primary endpoint was a composite of HF hospitalizations and death during follow‐up. Results: 54 patients (Age 64.0 ± 13.8 years; 58% male; left ventricular ejection fraction (LVEF) 28.4 ± 1.3%) were prospectively included. After a mean follow‐up of 31 ± 12.9months, the primary endpoint had occurred in 18 (33.3%) patients. A lower TAPSE/PASP ratio was associated with baseline worse HF symptoms, lower LVEF and long‐term less LV reverse remodeling ( P < .05). After one year CRT improved RV systolic function (TAPSE, RV global longitudinal strain, P < .05), but not TAPSE/PASP ratio ( P = .4). The ratio TAPSE/PASP (AUC=0.834) ≥ 0.58 mm/mm Hg showed good sensitivity (90%) and specificity (81.8%) for predicting response to CRT while a ratio <0.58 mm/mm Hg was associated with a higher risk of death and HF hospitalizations during the follow‐up (HR 5.37 95%CI [1.6–18], P < .001). Conclusion: RV‐PA coupling evaluation using TAPSE/PASP ratio predicts CRT response. A lower TAPSE/PASP ratio is associated with a higher risk of adverse cardiovascular events.