Vol 80, No 2 (2022)
Original article
Published online: 2021-12-23

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Non-invasive right ventriculo-arterial coupling as a rehospitalization predictor in dilated cardiomyopathy: A comparison of five different methods

Aura Vîjîiac12, Vlad Bătăilă2, Sebastian Onciul12, Violeta Verinceanu2, Claudia Guzu2, Silvia Deaconu12, Ioana Petre12, Alina Scărlătescu2, Diana Zamfir2, Maria Dorobanţu12
Pubmed: 34939658
Kardiol Pol 2022;80(2):182-190.

Abstract

Background: Right ventricular (RV) pulmonary artery coupling (RVPAC) is a predictor of outcome in left-sided heart failure (HF). Several echocardiographic estimates for RVPAC have been proposed.
Aims: This study aimed to compare multiple non-invasive methods to calculate RVPAC and to assess its prognostic role in patients with dilated cardiomyopathy (DCM).  
Methods: We prospectively enrolled 60 stable patients with DCM. RVPAC was estimated using five methods: as the tricuspid annular plane excursion/pulmonary artery systolic pressure (PASP) ratio; as the RV global longitudinal strain/PASP ratio; as the RV free wall strain (RVFW-LS)/PASP ratio; as the three-dimensional (3D) RV ejection fraction (RVEF)/PASP ratio; and as the 3D RV stroke volume (SV)/end-systolic volume (ESV) ratio. Patients were followed for a mean period of 18 (9) months for the endpoint of HF rehospitalizations.
Results: Twenty-nine patients (48%) reached the endpoint. All RVPAC estimates were more impaired in those patients reaching the endpoint (P <0.001 for all) and all predicted rehospitalizations in un-adjusted analysis. RVFW-LS/PASP and RVEF/PASP remained independent predictors of events, after adjustment for clinical and echocardiographic confounders. Using cut-offs obtained from receiver operating characteristic (ROC) analysis, we found that patients with RVFW-LS/PASP >–0.40 and patients with RVEF/PASP <1.30 had a higher risk of HF rehospitalization (log-rank P = 0.001 and P = 0.002, respectively).
Conclusion: RVFW-LS/PASP and RVEF/PASP as non-invasive estimates of RVPAC are independent predictors of HF rehospitalization in patients with DCM.

References

  1. Nagata Y, Wu VCC, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ Cardiovasc Imaging. 2017; 10(2).
  2. Seo J, Jung InH, Park JH, et al. The prognostic value of 2D strain in assessment of the right ventricle in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2019; 20(9): 1043–1050.
  3. Fine NM, Chen L, Bastiansen PM, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging. 2013; 6(5): 711–721.
  4. Carluccio E, Biagioli P, Alunni G, et al. Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion. Circ Cardiovasc Imaging. 2018; 11(1): e006894.
  5. Vîjîiac A, Onciul S, Guzu C, et al. The prognostic value of right ventricular longitudinal strain and 3D ejection fraction in patients with dilated cardiomyopathy. Int J Cardiovasc Imaging. 2021; 37(11): 3233–3244.
  6. Guazzi M, Dixon D, Labate V, et al. RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes. JACC Cardiovasc Imaging. 2017; 10(10 Pt B): 1211–1221.
  7. Ikonomidis I, Aboyans V, Blacher J, et al. The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association. Eur J Heart Fail. 2019; 21(4): 402–424.
  8. Monge García MI, Santos A. Understanding ventriculo-arterial coupling. Ann Transl Med. 2020; 8(12): 795.
  9. Brimioulle S, Wauthy P, Ewalenko P, et al. Single-beat estimation of right ventricular end-systolic pressure-volume relationship. Am J Physiol Heart Circ Physiol. 2003; 284(5): H1625–H1630.
  10. Schmeisser A, Rauwolf T, Groscheck T, et al. Pressure-volume loop validation of TAPSE/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension. Eur Heart J Cardiovasc Imaging. 2021; 22(2): 168–176.
  11. Nochioka K, Querejeta Roca G, Claggett B, et al. Right ventricular function, right ventricular-pulmonary artery coupling, and heart failure risk in 4 US communities: the atherosclerosis risk in communities (ARIC) study. JAMA Cardiol. 2018; 3(10): 939–948.
  12. Iacoviello M, Monitillo F, Citarelli G, et al. 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. Int J Cardiol. 2017; 241: 318–321.
  13. Pestelli G, Fiorencis A, Trevisan F, et al. New measures of right ventricle-pulmonary artery coupling in heart failure: An all-cause mortality echocardiographic study. Int J Cardiol. 2021; 329: 234–241.
  14. Pinto YM, Elliott PM, Arbustini E, et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2016; 37(23): 1850–1858.
  15. Lang RM, Badano PL, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of, Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(4): 412.
  16. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32(1): 1–64.
  17. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a Registered Branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23(7): 685–713.
  18. Muraru D, Onciul S, Peluso D, et al. Sex- and method-specific reference values for right ventricular strain by 2-dimensional speckle-tracking echocardiography. Circ Cardiovasc Imaging. 2016; 9(2): e003866.
  19. Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6): 591–600.
  20. Muraru D, Spadotto V, Cecchetto A, et al. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging. 2016; 17(11): 1279–1289.
  21. Tello K, Wan J, Dalmer A, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension. Circulation: Cardiovascular Imaging. 2019; 12(9).
  22. Bosch L, Lam CSP, Gong L, et al. Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction. Eur J Heart Fail. 2017; 19(12): 1664–1671.
  23. Deaconu S, Deaconu A, Scarlatescu A, et al. Ratio between right ventricular longitudinal strain and pulmonary arterial systolic pressure: novel prognostic parameter in patients undergoing cardiac resynchronization therapy. J Clin Med. 2021; 10(11).
  24. Aubert R, Venner C, Huttin O, et al. Three-Dimensional echocardiography for the assessment of right ventriculo-arterial coupling. J Am Soc Echocardiogr. 2018; 31(8): 905–915.
  25. Jone PN, Schäfer M, Pan Z, et al. Right ventricular-arterial coupling ratio derived from 3-dimensional echocardiography predicts outcomes in pediatric pulmonary hypertension. Circ Cardiovasc Imaging. 2019; 12(1): e008176.
  26. Vonk Noordegraaf A, Westerhof BE, Westerhof N. The relationship between the right ventricle and its load in pulmonary hypertension. J Am Coll Cardiol. 2017; 69(2): 236–243.
  27. Todaro MC, Carerj S, Zito C, et al. Echocardiographic evaluation of right ventricular-arterial coupling in pulmonary hypertension. Am J Cardiovasc Dis. 2020; 10(4): 272–283.
  28. Zaidi A, Knight DS, Augustine DX, et al. Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography. Echo Res Pract. 2020; 7(1): G19–G41.
  29. Adir Y, Guazzi M, Offer A, et al. all investigators. Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction. Eur J Heart Fail. 2017; 19(7): 873–879.
  30. Brand A, Bathe M, Oertelt-Prigione S, et al. Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function. Echocardiography. 2018; 35(1): 47–55.
  31. Carluccio E, Biagioli P, Lauciello R, et al. Superior prognostic value of right ventricular free wall compared to global longitudinal strain in patients with heart failure. J Am Soc Echocardiogr. 2019; 32(7): 836–844.e1.
  32. Lopez-Candales A, Hernandez-Suarez DF. Strain imaging echocardiography: what imaging cardiologists should know. Curr Cardiol Rev. 2017; 13(2): 118–129.
  33. Sciaccaluga C, D'Ascenzi F, Mandoli GE, et al. Traditional and novel imaging of right ventricular function in patients with heart failure and reduced ejection fraction. Curr Heart Fail Rep. 2020; 17(2): 28–33.
  34. Kalogeropoulos AP, Butler J. Left ventricular ejection fraction in patients with acute heart failure: a limited tool? Rev Esp Cardiol (Engl Ed). 2017; 70(5): 318–319.
  35. Dziewięcka E, Gliniak M, Winiarczyk M, et al. The burden of atrial fibrillation and its prognostic value in patients with dilated cardiomyopathy. Kardiol Pol. 2020; 78(1): 37–44.



Polish Heart Journal (Kardiologia Polska)