Background:The ratios of tricuspid annular plane systolic excursion (TAPSE)/echocardiographically measured systolic pulmonary artery pressure (PASP), fractional area change/invasively measured mean pulmonary artery pressure, right ventricular (RV) area change/end-systolic area, TAPSE/pulmonary artery acceleration time, and stroke volume/end-systolic area have been proposed as surrogates of RV-arterial coupling. The relationship of these surrogates with the gold standard measure of RV-arterial coupling (invasive pressure-volume loop-derived end-systolic/arterial elastance [Ees/Ea] ratio) and RV diastolic stiffness (end-diastolic elastance) in pulmonary hypertension remains incompletely understood. We evaluated the relationship of these surrogates with invasive pressure-volume loop-derived Ees/Ea and end-diastolic elastance in pulmonary hypertension.Methods:We performed right heart echocardiography and cardiac magnetic resonance imaging 1 day before invasive measurement of pulmonary hemodynamics and single-beat RV pressure-volume loops in 52 patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. The relationships of the proposed surrogates with Ees/Ea and end-diastolic elastance were evaluated by Spearman correlation, multivariate logistic regression, and receiver operating characteristic analyses. Associations with prognosis were evaluated by Kaplan-Meier analysis.Results:TAPSE/PASP, fractional area change/mean pulmonary artery pressure, RV area change/end-systolic area, and stroke volume/end-systolic area but not TAPSE/pulmonary artery acceleration time were correlated with Ees/Ea and end-diastolic elastance. Of the surrogates, only TAPSE/PASP emerged as an independent predictor of Ees/Ea (multivariate odds ratio: 18.6; 95% CI, 0.8–96.1; P=0.08). In receiver operating characteristic analysis, a TAPSE/PASP cutoff of 0.31 mm/mm Hg (sensitivity: 87.5% and specificity: 75.9%) discriminated RV-arterial uncoupling (Ees/Ea <0.805). Patients with TAPSE/PASP <0.31 mm/mm Hg had a significantly worse prognosis than those with higher TAPSE/PASP.Conclusions:Echocardiographically determined TAPSE/PASP is a straightforward noninvasive measure of RV-arterial coupling and is affected by RV diastolic stiffness in severe pulmonary hypertension.Clinical Trial Registration:URL: https://www.clinicaltrials.gov. Unique identifier: NCT03403868.

中文翻译：

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验证三尖瓣环状平面收缩期运动/收缩期肺动脉压力比在评估严重肺动脉高压中右心室-动脉耦合中的作用。

背景：三尖瓣环平面收缩期偏移（TAPSE）/超声心动图测得的收缩期肺动脉压（PASP），分数面积变化/有创测量的平均肺动脉压，右心室（RV）面积变化/收缩末期面积，TAPSE /肺动脉加速时间和中风量/收缩末期面积已被提议作为RV-动脉耦合的替代物。这些替代物与肺动脉高压中RV-动脉偶合的金标准测量值（侵入性压力-体积环衍生的收缩末期/动脉弹性[Ees / Ea]之比）和RV舒张僵硬度（舒张末期弹性）之间的关系仍然存在不完全了解。我们评估了这些替代物与肺动脉高压中侵入性压力体积环衍生的Ees / Ea和舒张末期弹性的关系。方法：我们在52例肺动脉高压或慢性血栓栓塞性肺动脉高压患者的侵入性测量肺血流动力学和单搏RV容积环之前1天进行了右心超声心动图和心脏磁共振成像。拟议的代理人与Ees / Ea和舒张末期弹性之间的关系通过Spearman相关性，多元逻辑回归和接收者工作特征分析进行了评估。通过Kaplan-Meier分析评估与预后的相关性。结果：TAPSE / PASP，面积变化/平均肺动脉压，RV面积变化/收缩末期面积，中风量/收缩末期面积，而非TAPSE /肺动脉加速时间与Ees / Ea和舒张末期弹性相关。在代理人中，P = 0.08）。在接收器工作特性分析中，TAPSE / PASP临界值为0.31 mm / mm Hg（灵敏度：87.5％，特异性：75.9％）区分了RV动脉解耦（Ees / Ea <0.805）。TAPSE / PASP <0.31 mm / mm Hg的患者的预后显着低于TAPSE / PASP较高的患者。结论：超声心动图确定的TAPSE / PASP是一种直接的无创测量RV动脉耦合的方法，在严重的情况下会受到RV舒张硬度的影响肺动脉高压。临床试验注册：URL：https://www.clinicaltrials.gov。唯一标识符：NCT03403868。