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Lee CY, Nabeshima Y, Kitano T, Parasca CA, Calin A, Popescu BA, Takeuchi M. Prognostic value of right ventricular free-wall longitudinal strain in aortic stenosis: A systematic review and meta-analysis. J Cardiol 2024; 84:80-85. [PMID: 38043709 DOI: 10.1016/j.jjcc.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Assessment of right ventricular (RV) function in aortic stenosis (AS) may improve risk stratification. However, whether the prognostic value of RV free-wall longitudinal strain (RVfwLS) is better than that of other right heart or pulmonary circulation parameters remains uncertain. This study assessed and compared the prognostic value of RVfwLS with traditional parameters in the AS population using a systematic review and meta-analysis. METHODS We selected studies reporting the hazard ratio (HR) of RVfwLS in patients with AS. We also collected data regarding the HR of systolic pulmonary arterial pressure (SPAP), fractional area change (FAC), and tricuspid annulus plane systolic excursion (TAPSE). To ensure comparability, we standardized the HR using within-study standard deviations. The comparison between the prognostic value of RVfwLS and other parameters was conducted as a ratio of HR. RESULTS This meta-analysis included 9 studies comprising a total of 2547 patients, with 679 events. The pooled HR of RVfwLS was 1.56 (95 % CI: 1.39-1.75, p < 0.001). When examining the ratio of HR between RVfwLS and conventional parameters, all comparisons were statistically non-significant [RVfwLS/SPAP: 1.28 (95 % CI: 0.99-1.65, p = 0.06); RVfwLS/FAC: 1.24 (95 % CI: 0.90-1.72, p = 0.14); and RVfwLS/TAPSE:1.07 (95 % CI: 0.75-1.52, p = 0.60)]. CONCLUSIONS This meta-analysis establishes a substantial association between RVfwLS and adverse outcomes in the AS population. However, comparative analysis between RVfwLS and SPAP, FAC, or TAPSE did not support the prognostic superiority of RVfwLS.
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Affiliation(s)
- Chung-Yen Lee
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yosuke Nabeshima
- Department of Cardiology, Saga University, School of Medicine, Saga, Japan
| | - Tetsuji Kitano
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Catalina A Parasca
- Cardiothoracic Department, University of Medicine and Pharmacy "Carol Davia", Bucharest, Romania; Cardiology and Cardiovascular Surgery Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Andreea Calin
- Cardiothoracic Department, University of Medicine and Pharmacy "Carol Davia", Bucharest, Romania; Cardiology and Cardiovascular Surgery Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Bogdan A Popescu
- Cardiothoracic Department, University of Medicine and Pharmacy "Carol Davia", Bucharest, Romania; Cardiology and Cardiovascular Surgery Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan.
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Culp C, Andrews J, Sun KW, Hunter K, Cherry A, Podgoreanu M, Nicoara A. Right Ventricle-Pulmonary Artery Coupling in Patients Undergoing Cardiac Interventions. Curr Cardiol Rep 2024; 26:521-537. [PMID: 38581563 DOI: 10.1007/s11886-024-02052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the fundamentals of RV-PA coupling, its non-invasive means of measurement, and contemporary understanding of RV-PA coupling in cardiac surgery, cardiac interventions, and congenital heart disease. RECENT FINDINGS The need for more accessible clinical means of evaluation of RV-PA coupling has driven researchers to investigate surrogates using cardiac MRI, echocardiography, and right-sided pressure measurements in patients undergoing cardiac surgery/interventions, as well as patients with congenital heart disease. Recent research has aimed to validate these alternative means against the gold standard, as well as establish cut-off values predictive of morbidity and/or mortality. This emerging evidence lays the groundwork for identifying appropriate RV-PA coupling surrogates and integrating them into perioperative clinical practice.
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Affiliation(s)
- Crosby Culp
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA.
| | - Jon Andrews
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Katherine Wang Sun
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado, Aurora, CO, USA
| | - Anne Cherry
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Mihai Podgoreanu
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University, 2301 Erwin Road, Box # 3094, Durham, NC, 27710, USA
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Beyls C, Yakoub-Agha M, Hermida A, Martin N, Crombet M, Hanquiez T, Fournier A, Jarry G, Malaquin D, Michaud A, Abou-Arab O, Leborgne L, Mahjoub Y. Prognostic Value of a New Right Ventricular-to-Pulmonary Artery Coupling Parameter Using Right Ventricular Longitudinal Shortening Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prospective Echocardiography Study. J Clin Med 2024; 13:1006. [PMID: 38398319 PMCID: PMC10889072 DOI: 10.3390/jcm13041006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58-0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49-0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg-1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38-74]) for patients with RV-LSF/PASP < 0.30%.mmHg-1 and 17% (95%CI = [12-23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg-1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg-1 was associated with MACE at 6 months.
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Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Mathilde Yakoub-Agha
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Alexis Hermida
- Rythmology Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France;
| | - Nicolas Martin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Maxime Crombet
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Thomas Hanquiez
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Alexandre Fournier
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Geneviève Jarry
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Dorothée Malaquin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Audrey Michaud
- Biostatistics Unit, Clinical Research and Innovation Directorate, Amiens-Picardie University Hospital Centre, F-80054 Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Laurent Leborgne
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
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Auffret V, Leurent G. Right Ventricular-Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement: Closer to Optimal Prognosis Assessment? JACC Cardiovasc Interv 2023; 16:1622-1625. [PMID: 37438028 DOI: 10.1016/j.jcin.2023.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Vincent Auffret
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, Rennes, France.
| | - Guillaume Leurent
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, Rennes, France
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