Extract
The adaptation of right ventricular (RV) systolic function to afterload is a major determinant of outcome in pulmonary hypertension (PH) [1]. The gold standard measurement of RV-pulmonary arterial (PA) coupling is the ratio of end-systolic to arterial elastances (Ees/Ea) which is optimal for RV flow output at minimal energy cost at values between 1.5 and 2 [2]. Progressive RV-PA uncoupling is associated with maintained RV dimensions down to Ees/Ea values of around 0.8 [3]. Thus, the evaluation of RV-PA coupling would theoretically allow monitoring of the transition from compensated to decompensated RV function in PH. However, measuring RV-PA coupling at the bedside is technically demanding and invasive. Therefore, simpler imaging surrogates are being evaluated. One of those is the ratio of tricuspid annular plane systolic excursion (TAPSE) as a surrogate of contractility and systolic pulmonary artery pressure (PASP) as a surrogate of afterload, both measured using echocardiography (M-mode for TAPSE and Doppler assessment of the maximum velocity of tricuspid regurgitation for PASP) [4]. The TAPSE/PASP ratio has emerged as a potent predictor of outcome in heart failure [5] as well as in pulmonary arterial hypertension (PAH) [6].
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Tello reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Actelion, personal fees from Bayer, outside the submitted work.
Conflict of interest: Dr. Ghofrani reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Bayer, personal fees from Actelion, personal fees from Pfizer, personal fees from Merck, personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from Bayer HealthCare, grants and personal fees from Encysive/Pfizer, grants from Aires, grants from German Research Foundation, grants from Excellence Cluster Cardiopulmonary Research, grants from German Ministry for Education and Research, personal fees from Takeda, outside the submitted work.
Conflict of interest: Dr. Heinze has nothing to disclose.
Conflict of interest: Dr. Krüger has nothing to disclose.
Conflict of interest: Dr. Naeije reports grants and personal fees from AOPOrphan Pharmaceuticals, grants and personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from Reata, grants and personal fees from Lung Biotechnology Corporation, grants and personal fees from United Therapeutics, outside the submitted work.
Conflict of interest: Dr. Raubach has nothing to disclose.
Conflict of interest: Dr. Seeger reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Pfizer, personal fees from Bayer Pharma AG, outside the submitted work.
Conflict of interest: Dr. Sommer reports personal fees from Actelion, outside the submitted work.
Conflict of interest: Dr. Gall reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; personal fees from Actelion, personal fees from AstraZeneca, personal fees from Bayer, personal fees from BMS, personal fees from GSK, personal fees from Janssen-Cilag, personal fees from Lilly, personal fees from MSD, personal fees from Novartis, personal fees from OMT, personal fees from Pfizer, personal fees from United Therapeutics, outside the submitted work.
Conflict of interest: Dr. Richter reports grants from German Research Foundation, non-financial support from University of Giessen, during the conduct of the study; grants from United Therapeutics, grants and personal fees from Bayer, personal fees from Actelion, personal fees from Mundipharma, personal fees from Roche, personal fees from OMT, outside the submitted work.
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