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Prognostic effect of left ventricular-pulmonary arterial coupling indicator in pulmonary arterial hypertension
Chuanxue Wan1, Mengqi Chen1, Jun Tong1
1Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Background:
Pulmonary arterial hypertension (PAH) patients require risk stratification for targeted drug therapy strategies. The risk stratification tool includes cardiac function classifications, hemodynamic, and echocardiographic indicators but lack measures of PAH impact on left ventricular diastolic function.
Methods:
In this single-center observational study, left ventricular-pulmonary arterial (LV-PA) coupling was assessed using the ratios of hemodynamically measured LV transmural pressure/mean pulmonary artery pressure (LVTMP/mPAP) or echocardiographically measured LV end-diastolic diameter/PASPe (LVEDD/PASPe). The associations of the LV-PA coupling indicators with prognosis were evaluated by Cox regression and Kaplan-Meier analyses. Correlations with hemodynamic parameters were assessed using Spearman analyses.
Main Results:
A total of 179 patients met the study criteria, with 74 patients (41.3 %) experienced clinical worsening events, including 19 deaths (10.6 %). Cox regression analyses identified four predictors of clinical worsening events, LVTMP (P = 0.005), LVEDD (P = 0.010), LVTMP/mPAP (P = 0.003), and LVEDD/PASPe (P = 0. 001). Kaplan-Meier curves revealed significantly higher clinical worsening events rate when LVTMP/mPAP <0.04 at baseline or LVEDD/PASPe <0.51 mm/mmHg at baseline. Spearman correlation analyses revealed that LVTMP/mPAP (R = -0.38, P < 0.001), LVEDD/PASPe (R = -0.60, P < 0.001) were significantly correlated with pulmonary vascular resistance (PVR).
Conclusion:
The LV-PA coupling indicators, LVTMP/mPAP and LVEDD/PASPe, are significant and independent predictors of prognosis in PAH patients and exhibit a direct correlation with the severity of PAH.
Clinical Trial Registration:
[ClinicalTrials.gov], identifier [NCT05417373], data[06/09/2022], retrospectively registered.
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