Optimal Method for Assessing Right Ventricular to Pulmonary Arterial Coupling in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis - 11/06/24
Highlights |
• | Echocardiographic coupling ratios identify occult right-sided cardiac dysfunction in healthy older adults. |
• | Echocardiographic coupling ratios are associated with 6-minute walk distance, N-terminal pro-B-type natriuretic peptide, and Kansas City Cardiomyopathy Questionnaire score. |
• | Across ratios, fractional area change/pulmonary artery systolic pressure best relates to age-related and gender-related functional and geometric changes. |
• | Incorporation of coupling ratios refines prediction of right ventricular dysfunction and pulmonary hypertension. |
Résumé |
Right ventricular (RV) to pulmonary arterial (PA) coupling describes the ability of the RV to augment contractility in response to increased afterload. Several echocardiographic indexes of RV-PA coupling have been defined; however, the optimal numerator in the coupling ratio is unclear. We sought to establish which of these ratios is best for assessing RV-PA coupling based on their relations with 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in aging adults. In this study of 1,611 Multi-Ethnic Study of Atherosclerosis participants who underwent echocardiography at Exam 6, we evaluated the association between different numerators, including tricuspid annular planar systolic excursion (TAPSE), fractional area change (FAC), RV free wall strain, and tissue Doppler imaging S’ velocity to pulmonary artery systolic pressure (PASP) with 6MWD, NT-proBNP, and KCCQ score, adjusted for socioeconomic and cardiovascular disease risk factors. Our cohort had a mean age of 73 ± 8 years, 54% female, 17% Chinese American, 22% African American, 22% Hispanic, and 39% White participants. The mean ( ± SD) TAPSE/PASP, FAC/PASP, tissue Doppler imaging S’ velocity/PASP, and RV free wall strain:PASP ratios were 0.7 ± 0.2, 1.3 ± 0.3, 0.5 ± 0.1, and 0.8 ± 0.2, respectively. All RV-PA coupling indices decreased with age (p <0.0001 for all). TAPSE:PASP ratio was lower in older (³85 years) female (0.59 ± 0.14) versus male (0.65 ± 0.17) participants (p = 0.01), whereas FAC/PASP ratio was higher in the same female versus male participants (p <0.01). TAPSE/PASP and FAC/PASP ratios were significantly and strongly associated with all NT-proBNP, 6MWD, and KCCQ scores in fully adjusted and receiver operating characteristic analysis. In older community-dwelling adults free of heart failure and pulmonary hypertension, both FAC/PASP and TAPSE:PASP ratios are optimal for assessment of RV-PA coupling based on its association with 6MWD, NT-proBNP, and KCCQ score. FAC/PASP ratio has the additional benefit of reflecting age and gender-related geometric and functional changes.
Le texte complet de cet article est disponible en PDF.Keywords : echocardiography, MESA, NT-proBNP, pulmonary artery systolic pressure, right ventricle
Plan
| Funding: This research was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (Bethesda, MD), and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (Bethesda, MD). |
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| Dr. Jani: National Scleroderma Foundation (Danvers, MA) Predoctoral Fellowship. Dr. Strom: National Institutes of Health/National Heart, Lung, and Blood Institute 1K23HL144907, R01AG063937; Edwards Lifesciences, Ultromics, HeartSciences, Anumana, and EchoIQ. Dr. Michos: Amato Fund for Women's Cardiovascular Health at Johns Hopkins and American Heart Association (Dallas, TX) grant 946222. Dr. Shah: National Institutes of Health R01 HL107577, R01 HL127028, R01 HL140731, and R01 HL149423; the American Heart Association (Dallas, Tx) (No. 16SFRN28780016), and research grants from Corvia, AstraZeneca, and Pfizer. Dr. Mukherjee: National Institutes of Health/National Heart, Lung, and Blood Institute R01HL162851, and the National Scleroderma Foundation. |
Vol 222
P. 11-19 - juillet 2024 Retour au numéro
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