Emergency Department, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Department of Cardiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
Clin Cardiol. 2024 Jul;47(7):e24308. doi: 10.1002/clc.24308.
Right ventricular-pulmonary artery coupling (RVPAC) refers to the relationship between right ventricular systolic force and afterload. The ratio of echocardiograph-derived tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) has been proposed as a noninvasive measurement of RVPAC and reported as an independent prognostic parameter of heart failure. However, it has not been adequately in detail evaluated in heart failure with preserved ejection fraction (HFpEF). We hypothesized that RVPAC may be used and proposed as an expression of key risk factors in patients with HFpEF.
We retrospectively analyzed TAPSE/PASP of 648 HFpEF patients hospitalized in Chongqing Hospital of Traditional Chinese Medicine from January 1, 2016 to January 1, 2017. All eligible patients were followed up for 5 years. The correlation between TAPSE/SPAP index and clinical indicators and outcomes was evaluated.
The final analysis included 414 patients. Nonsurvivors had significantly lower TAPSE, TAPSE/PASP and higher PASP compared with survivors (p < 0.0001). ROC curve analysis showed that the optimal cutoff of TAPSE, PASP, and RVPAC to predict all-cause death were 16.5 mm, 37.5 mmHg, and 0.45 mm/mmHg, respectively. In multivariate Cox regression analyses adjusted for gender showed a significant, independent association of the RVPAC with the composite endpoint of all-cause death or HF-related recurrent hospitalization (HR: 0.006; 95% CI 0.001-0.057, p < 0.001).
RVPAC, defined by the ratio of TAPSE to PASP, is the expression of a key risk factor in HFpEF patients, which is independently associated with the composite endpoint of all-cause death or HF-related recurrent hospitalization.
右心室-肺动脉偶联（RVPAC）是指右心室收缩力与后负荷之间的关系。超声心动图衍生的三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（PASP）的比值已被提出作为 RVPAC 的无创测量方法，并被报道为心力衰竭的独立预后参数。然而，它在射血分数保留的心力衰竭（HFpEF）中尚未得到充分详细评估。我们假设 RVPAC 可用于并提出作为 HFpEF 患者关键危险因素的表达。
我们回顾性分析了 2016 年 1 月 1 日至 2017 年 1 月 1 日期间在重庆市中医院住院的 648 例 HFpEF 患者的 TAPSE/PASP。所有符合条件的患者均进行了 5 年随访。评估了 TAPSE/SPAP 指数与临床指标和结局的相关性。
最终分析包括 414 例患者。与幸存者相比，非幸存者的 TAPSE、TAPSE/PASP 明显较低，PASP 明显较高（p < 0.0001）。ROC 曲线分析显示，TAPSE、PASP 和 RVPAC 预测全因死亡的最佳截断值分别为 16.5 mm、37.5 mmHg 和 0.45 mm/mmHg。在调整性别后的多变量 Cox 回归分析中，RVPAC 与全因死亡或 HF 相关再入院的复合终点有显著、独立的关联（HR：0.006；95%CI 0.001-0.057，p < 0.001）。
由 TAPSE 与 PASP 的比值定义的 RVPAC 是 HFpEF 患者关键危险因素的表达，与全因死亡或 HF 相关再入院的复合终点独立相关。
