Evaluation of right ventricular-arterial coupling in chronic heart failure and pulmonary hypertension

Rationale. Right ventricular dysfunction plays an important role in the course of chronic heart failure and its outcomes. Right ventricular systolic function is closely related to afterload; therefore, it is important to assess right ventricular-arterial coupling.

Objective. To determine the values of right ventricular-arterial coupling (RVAC) parameters during transthoracic echocardiography in healthy subjects and in patients with chronic heart failure and pulmonary hypertension.

Material and methods. 41 patients with chronic heart failure due to coronary heart disease or dilated cardiomyopathy with signs of PH were examined. The average age of the patients was 69.2 ± 10.1 years; 12 women (29%), 29 men (71%). In 27 of patients with CHF and PH (65.9%), the left ventricular ejection fraction (LVEF) was within normal limits. Echocardiographic examination assessed various parameters of RVAC, such as the ratios of TAPSE (tricuspid annular plane systolic excursion), peak systolic tissue velocity of the lateral tricuspid annulus (S′), RVFAC (fractional area change), RVGLS, and RVFWLS to pulmonary artery systolic pressure (PASP).

Results. In patients with chronic heart failure and pulmonary hypertension, all measures of RVAC were significantly different from the control group  (P < 0.0001), regardless of the left ventricular ejection fraction value. All the indicators of RVAC demonstrated high sensitivity and specificity in relation to RV-arterial uncoupling. In the control group, there was a decrease in RVAC rates in older individuals. The most diagnostic accuracy among RVAC parameters was demonstrated by RVGLS/PASP and RVFWLS/PASP.

Conclusions. Application of RVAC parameters in the RV function assessment increases the detection of RV-arterial uncoupling in chronic heart failure and pulmonary hypertension. 

1. 1 Todaro MC, Carerj S, Zito C, Trifirò MP, Consolo G, Khandheria B. Echocardiographic evaluation of right ventricular-arterial coupling in pulmonary hypertension. Am J Cardiovasc Dis. 2020 Oct 15;10(4):272-283. PMID: 33224574; PMCID: PMC7675169.

2. 2 Thandavarayan R.A., Chitturi K.R., Guha A. Pathophysiology of acute and chronic right heart failure. Cardiol. Clin. 2020;38(2):149–160. https://doi.org/10.1016/j.ccl.2020.01.009

3. 3 Chazova I.E., Martynyuk T.V., Valieva Z.S., Azizov V.A.-O., Barbarash O.L., Veselova T.N., Galyavich A.S. et al. Diagnosis and treatment of pulmonary hypertension. Eurasian Journal of Cardiology. 2020;1:78–124. (In Russ.). URL: https://cyberleninka.ru/article/n/diagnostika-i-lechenie-lyogochnoy-gipertenzii (дата обращения: 08.10.2024).

4. 4 Tello K, Wan J, Dalmer A, Vanderpool R, Ghofrani HA, Naeije R, Roller F, Mohajerani E, Seeger W, Herberg U, Sommer N, Gall H, Richter MJ. 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. Circ Cardiovasc Imaging. 2019 Sep;12(9):e009047. https://doi.org/10.1161/CIRCIMAGING.119.009047. Epub 2019 Sep 10. PMID: 31500448; PMCID: PMC7099862.

5. 5 Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica MJ, Shah SJ. 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 Oct;10(10 Pt B):1211-1221. https://doi.org/10.1016/j.jcmg.2016.12.024. Epub 2017 Apr 12. PMID: 28412423.

6. 6 Islamova M.R., Lazarev P.V., Safarova A.F., Kobalava Zh.D. The Value of Right Ventricular Dysfunction and Right Ventricular-Pulmonary Artery Coupling in Chronic Heart Failure: The Role of Echocardiography. Kardiologiia. 2018;58(5):82–90. (In Russ.). https://doi.org/10.18087/cardio. 2018.5.10124

7. 7 Ishiwata J, Daimon M, Nakanishi K, Sugimoto T, Kawata T, Shinozaki T, Nakao T, Hirokawa M, Sawada N, Yoshida Y, Amiya E, Hatano M, Morita H, Yatomi Y, Komuro I. Combined evaluation of right ventricular function using echocardiography in non-ischaemic dilated cardiomyopathy. ESC Heart Fail. 2021 Oct;8(5):3947-3956. https://doi.org/10.1002/ehf2.13519. Epub 2021 Aug 4. PMID: 34346188; PMCID: PMC8497345.

8. 8 Jentzer JC, Anavekar NS, Reddy YNV, Murphree DH, Wiley BM, Oh JK, Borlaug BA. Right Ventricular Pulmonary Artery Coupling and Mortality in Cardiac Intensive Care Unit Patients. J Am Heart Assoc. 2021 Apr 6;10(7):e019015. https://doi.org/10.1161/JAHA.120.019015. Epub 2021 Mar 28. PMID: 33775107; PMCID: PMC8174347.

9. 9 Fortuni F, Butcher SC, Dietz MF, van der Bijl P, Prihadi EA, De Ferrari GM, Ajmone Marsan N, Bax JJ, Delgado V. Right Ventricular-Pulmonary Arterial Coupling in Secondary Tricuspid Regurgitation. Am J Cardiol. 2021 Jun 1;148:138-145. https://doi.org/10.1016/j.amjcard.2021.02.037. Epub 2021 Mar 3. PMID: 33667451.

10. 10 Ferrara F., Rudski L.G., Vriz O., Gargani L., Afilalo J., D'Andrea A., D'Alto M., Marra A.M., Acri E., Stanziola A.A., Ghio S., Cittadini A., Naeije R., Bossone E. Physiologic correlates of tricuspid annular plane systolic excursion in 1168 healthy subjects. Int. J. Cardiol. 2016;223:736–743. https://doi.org/10.1016/j.ijcard.2016.08.275

11. 11 Bosch L, Lam CSP, Gong L, Chan SP, Sim D, Yeo D, Jaufeerally F, Leong KTG, Ong HY, Ng TP, Richards AM, Arslan F, Ling LH. Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction. Eur J Heart Fail. 2017 Dec;19(12):1664-1671. https://doi.org/10.1002/ejhf.873. Epub 2017 Jun 8. PMID: 28597497.

12. 12 Rudski L.G., Lai W.W., Afilalo J., Hua L., Handschumacher M.D., Chandrasekaran K., Solomon S.D., Louie E.K., Schiller N.B. 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. https://doi.org/10.1016/j.echo.2010.05.010

13. 13 Mukherjee M, Rudski LG, Addetia K, Afilalo J, D'Alto M, Freed BH, Friend LB, Gargani L, Grapsa J, Hassoun PM, Hua L, Kim J, Mercurio V, Saggar R, Vonk-Noordegraaf A. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2025 Mar;38(3):141186. https://doi.org/10.1016/j.echo.2025.01.006. PMID: 40044341.

14. 14 Galyavich A.S., Tereshchenko S.N., Uskach T.M., Ageev F.T., Aronov D.M., Arutyunov G.P., Begrambekova Yu.L. et al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):6162. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6162

15. 15 Ghio S, Guazzi M, Scardovi AB, Klersy C, Clemenza F, Carluccio E, Temporelli PL, Rossi A, Faggiano P, Traversi E, Vriz O, Dini FL; 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 Jul;19(7):873-879. https://doi.org/10.1002/ejhf.664. Epub 2016 Nov 17. PMID: 27860029.

16. 16 Rako ZA, Kremer N, Yogeswaran A, Richter MJ, Tello K. Adaptive versus maladaptive right ventricular remodelling. ESC Heart Fail. 2023 Apr;10(2):762-775. https://doi.org/10.1002/ehf2.14233. Epub 2022 Nov 23. PMID: 36419369; PMCID: PMC10053363.

17. 17 Brener MI, Grayburn P, Lindenfeld J, Burkhoff D, Liu M, Zhou Z, Alu MC, Medvedofsky DA, Asch FM, Weissman NJ, Bax J, Abraham W, Mack MJ, Stone GW, Hahn RT. Right Ventricular-Pulmonary Arterial Coupling in Patients With HF Secondary MR: Analysis From the COAPT Trial. JACC Cardiovasc Interv. 2021 Oct 25;14(20):2231-2242. https://doi.org/10.1016/j.jcin.2021.07.047. PMID: 34674862.

18. 18 Iacoviello M, Monitillo F, Citarelli G, Leone M, Grande D, Antoncecchi V, Rizzo C, Terlizzese P, Romito R, Caldarola P, Ciccone MM. 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 Aug 15;241:318-321. https://doi.org/10.1016/j.ijcard.2017.04.051. Epub 2017 May 1. PMID: 28479093.

19. 19 Wu VC, Takeuchi M. Echocardiographic assessment of right ventricular systolic function. Cardiovasc Diagn Ther. 2018;8(1):70-79. doi:10.21037/cdt.2017.06.05

20. 20 Kittipovanonth M, Bellavia D, Chandrasekaran K, Villarraga HR, Abraham TP, Pellikka PA. Doppler myocardial imaging for early detection of right ventricular dysfunction in patients with pulmonary hypertension. J Am Soc Echocardiogr. 2008;21(9):1035-1041.