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3 results on '"right ventricle to pulmonary artery coupling"'

1. Right Ventricle to Pulmonary Artery Coupling Predicts the Risk Stratification in Patients With Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

Author

Jinzhi Lai, Jiuliang Zhao, Kaiwen Li, Xiaohan Qin, Hui Wang, Zhuang Tian, Qian Wang, Mengtao Li, Xiaoxiao Guo, Yongtai Liu, and Xiaofeng Zeng

Subjects
pulmonary arterial hypertension, systemic sclerosis, right ventricle to pulmonary artery coupling, TAPSE/PASP, echocardiography, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundPulmonary arterial hypertension (PAH) is a serious complication of systemic sclerosis (SSc). PAH has high mortality, and risk assessment is critical for proper management. Whether the right ventricle to pulmonary artery (RV-PA) coupling accurately assesses risk status and predicts prognosis in patients with SSc-associated PAH has not been investigated.MethodsBetween March 2010 and July 2018, 60 consecutive patients with SSc-associated PAH diagnosed by right heart catheterization were enrolled prospectively, and the mean follow-up period was 52.9 ± 27.0 months. The RV-PA coupling was assessed by the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) which was obtained by transthoracic echocardiography. The simplified risk stratification strategy was applied to assess the risk level of participants, and the endpoint was a composite of all-cause death and clinical worsening.ResultsThe receiver operating characteristic (ROC) curve of the ability to determine high-risk patients identified the optimal cut-off value of the TAPSE/PASP ratio as 0.194 mm/mmHg, and the ratio appeared to be a reliable indicator in the stratification of patients with high risk (area under the curve = 0.878, ROC P-value = 0.003), which showed the highest positive likelihood ratio (LR) (5.4) and the lowest negative LR (0) among a series of echocardiographic parameters. The TAPSE/PASP ratio was an independent predictive factor (HR = 0.01, 95% CI: 0.00–0.77, P = 0.037) for the composite endpoint, and patients with a TAPSE/PASP ratio >0.194 had a better overall survival for both the composite endpoint (log-rank χ2 = 5.961, P = 0.015) and all-cause mortality (log-rank χ2 = 8.004, P = 0.005) compared to the patients with a TAPSE/PASP ≤ 0.194.ConclusionRV-PA coupling assessed by the TAPSE/PASP ratio provides added value as a straightforward and non-invasive approach for predicting risk stratification of patients with SSc-associated PAH. Meanwhile, a lower TAPSE/PASP ratio identified a subgroup with worse prognosis.

Published
2022
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2. Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients

Author

Adamo, Marianna, Maccagni, Gloria, Fiorina, Claudia, Giannini, Cristina, Angelillis, Marco, Costa, Giulia, Trani, Carlo, Burzotta, Francesco, Bruschi, Giuseppe, Merlanti, Bruno, Poli, Arnaldo, Ferrara, Erica, Fineschi, Massimo, Iadanza, Alessandro, Chizzola, Giuliano, Metra, Marco, Trani, Carlo (ORCID:0000-0001-9777-013X), Burzotta, Francesco (ORCID:0000-0002-6569-9401), Adamo, Marianna, Maccagni, Gloria, Fiorina, Claudia, Giannini, Cristina, Angelillis, Marco, Costa, Giulia, Trani, Carlo, Burzotta, Francesco, Bruschi, Giuseppe, Merlanti, Bruno, Poli, Arnaldo, Ferrara, Erica, Fineschi, Massimo, Iadanza, Alessandro, Chizzola, Giuliano, Metra, Marco, Trani, Carlo (ORCID:0000-0001-9777-013X), and Burzotta, Francesco (ORCID:0000-0002-6569-9401)

Abstract

Aims To investigate the impact of the right ventricle to pulmonary artery (RV-PA) coupling on the outcome of patients undergoing transcatheter aortic valve intervention (TAVI), and to describe changes in right ventricular function, pulmonary hypertension, and their ratio after TAVI. Methods Three hundred and seventy-seven patients from the Italian ClinicalService Project, who underwent TAVI between February 2011 and August 2020, were included. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was retrospectively calculated as a surrogate of RV-PA coupling. The population was stratified according to TAPSE/PASP using a cut-off of 0.36 mm/mmHg derived from a receiving operating characteristic (ROC) curve. The primary end point was 6-month all-cause death. Results Compared with patients with a TAPSE/PASP ratio >= 0.36 mm/mmHg (81%), those with TAPSE/PASP ratio <0.36 mm/mmHg (19%) had more comorbidities and were more symptomatic. Moreover, they were more likely to receive general anesthesia and an old generation device. Device success was similar between the two groups. A TAPSE/PASP ratio <0.36 mm/mmHg was associated with a higher risk of all-cause death at 6-months (17.3% versus 5.3%; adjusted HR 2.66; P = 0.041). The prognostic impact of the TAPSE/PASP ratio was stronger than the impact of TAPSE and PASP as separate parameters and was independent of the surgical risk score. Both TAPSE, PASP, and their ratio improved from baseline to 1 month and 6 months after TAVI. Conclusions A TAPSE/PASP ratio <0.36 mm/mmHg is strongly associated with an increased risk of mortality after TAVI. Providing a left ventricle unloading, TAVI is associated with improvement of both TAPSE, PASP, and their ratio.

Published
2022

3. Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients

Author

Marianna Adamo, Gloria Maccagni, Claudia Fiorina, Cristina Giannini, Marco Angelillis, Giulia Costa, Carlo Trani, Francesco Burzotta, Giuseppe Bruschi, Bruno Merlanti, Arnaldo Poli, Erica Ferrara, Massimo Fineschi, Alessandro Iadanza, Giuliano Chizzola, and Marco Metra

Subjects
Heart Failure, Heart Ventricles, Ventricular Dysfunction, Right, Doppler, General Medicine, Pulmonary Artery, Prognosis, mortality, Echocardiography, Doppler, Transcatheter Aortic Valve Replacement, Right, right ventricle to pulmonary artery coupling, transcatheter aortic valve implantation, Humans, Retrospective Studies, Ventricular Function, Right, Echocardiography, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Ventricular Dysfunction, Ventricular Function, Cardiology and Cardiovascular Medicine
Abstract

To investigate the impact of the right ventricle to pulmonary artery (RV-PA) coupling on the outcome of patients undergoing transcatheter aortic valve intervention (TAVI), and to describe changes in right ventricular function, pulmonary hypertension, and their ratio after TAVI.Three hundred and seventy-seven patients from the Italian ClinicalService Project, who underwent TAVI between February 2011 and August 2020, were included. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was retrospectively calculated as a surrogate of RV-PA coupling. The population was stratified according to TAPSE/PASP using a cut-off of 0.36 mm/mmHg derived from a receiving operating characteristic (ROC) curve. The primary end point was 6-month all-cause death.Compared with patients with a TAPSE/PASP ratio ≥0.36 mm/mmHg (81%), those with TAPSE/PASP ratio0.36 mm/mmHg (19%) had more comorbidities and were more symptomatic.Moreover, they were more likely to receive general anesthesia and an old generation device. Device success was similar between the two groups. A TAPSE/PASP ratio0.36 mm/mmHg was associated with a higher risk of all-cause death at 6-months (17.3% versus 5.3%; adjusted HR 2.66; P = 0.041). The prognostic impact of the TAPSE/PASP ratio was stronger than the impact of TAPSE and PASP as separate parameters and was independent of the surgical risk score. Both TAPSE, PASP, and their ratio improved from baseline to 1 month and 6 months after TAVI.A TAPSE/PASP ratio0.36 mm/mmHg is strongly associated with an increased risk of mortality after TAVI. Providing a left ventricle unloading, TAVI is associated with improvement of both TAPSE, PASP, and their ratio.

Published
2022

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