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.