Echocardiographic evaluations of right ventriculo–arterial coupling in experimental and clinical pulmonary hypertension

Abstract

Background: Tricuspid annular systolic excursion (TAPSE) or velocities (s′) and right ventricular (RV) end-systolic dimensions are predictors of outcome in patients with pulmonary hypertension (PH). We explored the value of combining peak s′ and RV end-systolic area index (RVESAi) as a surrogate of RV-pulmonary artery (RV–PA) coupling in a large animal of precapillary PH as well as clinically. Method: The first experimental group included four control and four piglets with thromboembolic disease. RV–PA coupling was assessed by ventricular to arterial elastance ratio (Ees/Ea) at baseline, after esmolol and dobutamine administration. Echocardiographic metrics included s′, TAPSE, fractional area change (RVFAC), and RVESAi. The findings were validated in six piglets with severe PH. Clinical cohorts were stable outpatients (n = 141) and acutely decompensated pulmonary arterial hypertension (n = 48). Results: In the first experimental group, the best linear correlates of Ees/Ea were s′ (R2 =.51, p