Right Ventricular-Pulmonary arterial (RV-PA) coupling is load independent and accurately predicts right ventricular function

Introduction

RV-PA coupling can be evaluated, using non-invasive surrogates such as Tricuspid annular plane systolic excursion/Systolic pulmonary artery pressure (TAPSE/SPAP) or RV free wall longitudinal strain/SPAP (RVFWLS/SPAP) emerged. The aim of the present study was: 1) Population 1: in Hemodialysis population (HD), to evaluate RV parameters during important load variations, immediately before and after HD. 2) Population 2: in routine cardiologic population, to evaluate the diagnostic value of RV-PA coupling for RV dysfunction

Method

Population 1: 85 patients (53 men), 64 ± 16 years old, had an echocardiography with RV analysis (s’, TAPSE, RVFWLS)immediately before starting HD(Pre-HD)and at the end of HD(Post-HD). Population 2: 96 patients (60 men), 64 ± 14 years old with various disease in the Department of cardiology had an echocardiography including RVFWLS,RV fractional area change(RVFAC), TAPSE,S’, Tei index, Isovolumic acceleration(IVA),and 3D RVEF. Patients were split in normal RV function (defined by 6 concordant normal indices) and RV dysfunction (defined by the presence of at least 3 abnormal indices)

Results

Population 1: TAPSE, s’, RVFWLS were significantly decreased in post-HD as compared to pre-HD; when indexing these parameters by SPAP (s’/SPAP, TAPSE/SPAP, RVFWLS/SPAP), they remain unchanged. Population 2: RVFWLS/SPAP and TAPSE/SPAP were significantly higher in normal RV function compared to dysfunction (1.02 ± 0.31 vs 0.57 ± 0.34 and 0.83 ± 0.20 vs 0.47 ± 0.21); diagnostic thresholds for RV dysfunction were 0.67 for RVFWLS/SPAP(sensitivity:95%, specificity:78%)and 0.63 for TAPSE/SPAP (sensitivity:86%, specificity:80%)

Conclusion

Surrogates of RV-PA coupling, such as TAPSE/SPAP or RVFWLS/SPAP are load independent in a HD population. Moreover, these parameters may contribute to precisely evaluate RV function.