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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
DOI: 10.33963/KP.a2021.0190
·
Pubmed: 34939658
Affiliations
  1. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  2. Emergency Clinical Hospital, Bucharest, Romania

open access

Online first
Original article
Published online: 2021-12-23

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: The aim of this study was 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: 29 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 unadjusted analysis. RVFW-LS/PASP and RVEF/PASP remained independent predictors of events, after adjusting for clinical and echocardiographic confounders. Using cut-offs obtained from ROC analysis, we found that patients with RVFW-LS/PASP >–0.40 and patients with RVEF/PASP < 1.30 had 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.

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: The aim of this study was 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: 29 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 unadjusted analysis. RVFW-LS/PASP and RVEF/PASP remained independent predictors of events, after adjusting for clinical and echocardiographic confounders. Using cut-offs obtained from ROC analysis, we found that patients with RVFW-LS/PASP >–0.40 and patients with RVEF/PASP < 1.30 had 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.

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Keywords

dilated cardiomyopathy, right ventricular-pulmonary artery coupling, RVEF/PASP ratio, RVFW-LS/PASP ratio

About this article
Title

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

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-12-23

DOI

10.33963/KP.a2021.0190

Pubmed

34939658

Keywords

dilated cardiomyopathy
right ventricular-pulmonary artery coupling
RVEF/PASP ratio
RVFW-LS/PASP ratio

Authors

Aura Vîjîiac
Vlad Bătăilă
Sebastian Onciul
Violeta Verinceanu
Claudia Guzu
Silvia Deaconu
Ioana Petre
Alina Scărlătescu
Diana Zamfir
Maria Dorobanţu

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