Right ventricular to pulmonary artery coupling in heart failure with preserved ejection fraction and secondary tricuspid regurgitation
M Mercurio, S Caravita, A Faini, D Muraru, G B Perego, A Iacovoni, M Senni, G Parati, L P Badano, C BarattoAbstract
Background
Secondary tricuspid regurgitation (TR) complicates heart failure with preserved ejection fraction (HFpEF), making assessment of right ventricular (RV) function challenging.
Purpose
To evaluate RV-pulmonary artery (PA) coupling in HFpEF-TR and its hemodynamic and three-dimensional echocardiographic (3DE) correlates.
Methods
Invasive RV pressure-volume loops were obtained in patients with HFpEF-TR, at rest (n=16) and during exercise (n=12). RV end-systolic elastance (Ees)[1], arterial elastance (Ea)[2], TR-adjusted pulmonary arterial elastance (Epa), and RV-PA coupling (Ees/Ea, Ees/Epa) were derived[3]. Correlations between RV-PA coupling, hemodynamics, and 3DE metrics were explored, including PA stroke volume (SVPA)/RV end-systolic volume (ESV)[4], effective RV ejection fraction (eRVEF)[5], TR regurgitant volume (RegVol) and fraction (RegFr)[6,7]. Characteristics of patients with preserved (ΔEes>0) versus exhausted (ΔEes≤0) RV reserve were compared[8].
Results
Ees/Ea overestimated RV-PA coupling as compared with Ees/Epa (Figure 1). Ees/Epa correlated with hemodynamic and 3DE metrics (Figure 2). During exercise, patients with exhausted RV contractile reserve (n=5/12) showed TR worsening (RegFr +6.6±13%vs–17±21%, p=0.05) and further RV-PA uncoupling (-0.10±0.09vs0.11±0.17, p=0.032).
Conclusions
In HFpEF-TR, RV–PA uncoupling was frequent, underestimated by TR-unadjusted metrics, and associated with hemodynamic compromise. 3DE-derived indexes were associated with Ees/Epa. Patients with exhausted RV reserve may present with TR worsening and further RV-PA uncoupling during exercise.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.