Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

Mads Dam Lyhne; Jacob Valentin Hansen; Stine Andersen; Jacob Gammelgaard Schultz; Simon Grund Sørensen; Mathilde Emilie Kirk; Victor Tang Merit; Mads Jønsson Andersen; Søren Mellemkjær; Lars Bo Ilkjær; David M Dudzinski; Jens Erik Nielsen-Kudsk; Asger Andersen

doi:10.1016/j.ijcard.2024.132639

Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

Mads Dam Lyhne, Jacob Valentin Hansen, Stine Andersen, Jacob Gammelgaard Schultz, Simon Grund Sørensen, Mathilde Emilie Kirk, Victor Tang Merit, Mads Jønsson Andersen, Søren Mellemkjær, Lars Bo Ilkjær, David M Dudzinski, Jens Erik Nielsen-Kudsk, Asger Andersen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by increased pulmonary vascular resistance (PVR) and pressure and right ventricular (RV) dysfunction. We aimed to evaluate the correlation of RV to pulmonary artery coupling, measured as the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and invasive hemodynamic measurements, and to assess the changes in this ratio following CTEPH treatment. Methods: We conducted a retrospective cohort study of CTEPH patients treated at Aarhus University Hospital with pulmonary angioplasty (BPA), pulmonary endarterectomy (PEA), and or medical therapy only. Patients underwent transthoracic echocardiography and right heart catheterization at baseline and follow-up. The primary endpoint was the association between TAPSE/PASP and PVR. Secondary endpoints included other hemodynamic and functional parameters. Results: The study included 139 patients. Mean TAPSE/PASP at baseline was 0.22 [0.16, 0.29] mm/mmHg. An exponential decay correlation was found between TAPSE/PASP and PVR (correlation coefficient − 0.67, p < 0.001). The TAPSE/PASP ratio improved from 0.23 [0.18; 0.29] to 0.33 [0.26; 0.46] mm/mmHg, p < 0.0001, following BPA, and from 0.20 [0.15;0.27] to 0.35 [0.21;0.41] mm/mmHg, p = 0.0007 following PEA, indicating enhanced RV to pulmonary artery coupling. Conclusion: In patients with CTEPH, the echocardiographic TAPSE/PASP ratio as a measure of RV-PA coupling correlates well with invasively measured pulmonary vascular resistance. The TAPSE/PASP ratio improved after BPA or PEA treatments suggesting a potential use for monitoring patient outcomes. Further prospective studies are warranted to establish the prognostic value of the TAPSE/PASP ratio and ability to guide treatment decisions.

Original language	English
Article number	132639
Journal	International Journal of Cardiology
Volume	418
Pages (from-to)	132639
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2024.132639
Publication status	Published - 1 Jan 2025

Keywords

Balloon pulmonary angioplasty
Echocardiography
Pulmonary circulation
Pulmonary endarterectomy
Right ventricular function
TAPSE/PASP

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10.1016/j.ijcard.2024.132639

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Lyhne, M. D., Hansen, J. V., Andersen, S., Schultz, J. G., Sørensen, S. G., Kirk, M. E., Merit, V. T., Andersen, M. J., Mellemkjær, S., Ilkjær, L. B., Dudzinski, D. M., Nielsen-Kudsk, J. E., & Andersen, A. (2025). Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension. International Journal of Cardiology, 418, 132639. Article 132639. https://doi.org/10.1016/j.ijcard.2024.132639

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title = "Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension",

abstract = "Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by increased pulmonary vascular resistance (PVR) and pressure and right ventricular (RV) dysfunction. We aimed to evaluate the correlation of RV to pulmonary artery coupling, measured as the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and invasive hemodynamic measurements, and to assess the changes in this ratio following CTEPH treatment. Methods: We conducted a retrospective cohort study of CTEPH patients treated at Aarhus University Hospital with pulmonary angioplasty (BPA), pulmonary endarterectomy (PEA), and or medical therapy only. Patients underwent transthoracic echocardiography and right heart catheterization at baseline and follow-up. The primary endpoint was the association between TAPSE/PASP and PVR. Secondary endpoints included other hemodynamic and functional parameters. Results: The study included 139 patients. Mean TAPSE/PASP at baseline was 0.22 [0.16, 0.29] mm/mmHg. An exponential decay correlation was found between TAPSE/PASP and PVR (correlation coefficient − 0.67, p < 0.001). The TAPSE/PASP ratio improved from 0.23 [0.18; 0.29] to 0.33 [0.26; 0.46] mm/mmHg, p < 0.0001, following BPA, and from 0.20 [0.15;0.27] to 0.35 [0.21;0.41] mm/mmHg, p = 0.0007 following PEA, indicating enhanced RV to pulmonary artery coupling. Conclusion: In patients with CTEPH, the echocardiographic TAPSE/PASP ratio as a measure of RV-PA coupling correlates well with invasively measured pulmonary vascular resistance. The TAPSE/PASP ratio improved after BPA or PEA treatments suggesting a potential use for monitoring patient outcomes. Further prospective studies are warranted to establish the prognostic value of the TAPSE/PASP ratio and ability to guide treatment decisions.",

keywords = "Balloon pulmonary angioplasty, Echocardiography, Pulmonary circulation, Pulmonary endarterectomy, Right ventricular function, TAPSE/PASP",

author = "Lyhne, {Mads Dam} and Hansen, {Jacob Valentin} and Stine Andersen and Schultz, {Jacob Gammelgaard} and S{\o}rensen, {Simon Grund} and Kirk, {Mathilde Emilie} and Merit, {Victor Tang} and Andersen, {Mads J{\o}nsson} and S{\o}ren Mellemkj{\ae}r and Ilkj{\ae}r, {Lars Bo} and Dudzinski, {David M} and Nielsen-Kudsk, {Jens Erik} and Asger Andersen",

year = "2025",

month = jan,

day = "1",

doi = "10.1016/j.ijcard.2024.132639",

language = "English",

volume = "418",

pages = "132639",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Lyhne, MD , Hansen, JV , Andersen, S , Schultz, JG , Sørensen, SG , Kirk, ME , Merit, VT , Andersen, MJ, Mellemkjær, S, Ilkjær, LB, Dudzinski, DM, Nielsen-Kudsk, JE & Andersen, A 2025, 'Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension', International Journal of Cardiology, vol. 418, 132639, pp. 132639. https://doi.org/10.1016/j.ijcard.2024.132639

Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension. / Lyhne, Mads Dam ; Hansen, Jacob Valentin ; Andersen, Stine et al.
In: International Journal of Cardiology, Vol. 418, 132639, 01.01.2025, p. 132639.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

AU - Lyhne, Mads Dam

AU - Hansen, Jacob Valentin

AU - Andersen, Stine

AU - Schultz, Jacob Gammelgaard

AU - Sørensen, Simon Grund

AU - Kirk, Mathilde Emilie

AU - Merit, Victor Tang

AU - Andersen, Mads Jønsson

AU - Mellemkjær, Søren

AU - Ilkjær, Lars Bo

AU - Dudzinski, David M

AU - Nielsen-Kudsk, Jens Erik

AU - Andersen, Asger

PY - 2025/1/1

Y1 - 2025/1/1

N2 - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by increased pulmonary vascular resistance (PVR) and pressure and right ventricular (RV) dysfunction. We aimed to evaluate the correlation of RV to pulmonary artery coupling, measured as the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and invasive hemodynamic measurements, and to assess the changes in this ratio following CTEPH treatment. Methods: We conducted a retrospective cohort study of CTEPH patients treated at Aarhus University Hospital with pulmonary angioplasty (BPA), pulmonary endarterectomy (PEA), and or medical therapy only. Patients underwent transthoracic echocardiography and right heart catheterization at baseline and follow-up. The primary endpoint was the association between TAPSE/PASP and PVR. Secondary endpoints included other hemodynamic and functional parameters. Results: The study included 139 patients. Mean TAPSE/PASP at baseline was 0.22 [0.16, 0.29] mm/mmHg. An exponential decay correlation was found between TAPSE/PASP and PVR (correlation coefficient − 0.67, p < 0.001). The TAPSE/PASP ratio improved from 0.23 [0.18; 0.29] to 0.33 [0.26; 0.46] mm/mmHg, p < 0.0001, following BPA, and from 0.20 [0.15;0.27] to 0.35 [0.21;0.41] mm/mmHg, p = 0.0007 following PEA, indicating enhanced RV to pulmonary artery coupling. Conclusion: In patients with CTEPH, the echocardiographic TAPSE/PASP ratio as a measure of RV-PA coupling correlates well with invasively measured pulmonary vascular resistance. The TAPSE/PASP ratio improved after BPA or PEA treatments suggesting a potential use for monitoring patient outcomes. Further prospective studies are warranted to establish the prognostic value of the TAPSE/PASP ratio and ability to guide treatment decisions.

AB - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by increased pulmonary vascular resistance (PVR) and pressure and right ventricular (RV) dysfunction. We aimed to evaluate the correlation of RV to pulmonary artery coupling, measured as the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and invasive hemodynamic measurements, and to assess the changes in this ratio following CTEPH treatment. Methods: We conducted a retrospective cohort study of CTEPH patients treated at Aarhus University Hospital with pulmonary angioplasty (BPA), pulmonary endarterectomy (PEA), and or medical therapy only. Patients underwent transthoracic echocardiography and right heart catheterization at baseline and follow-up. The primary endpoint was the association between TAPSE/PASP and PVR. Secondary endpoints included other hemodynamic and functional parameters. Results: The study included 139 patients. Mean TAPSE/PASP at baseline was 0.22 [0.16, 0.29] mm/mmHg. An exponential decay correlation was found between TAPSE/PASP and PVR (correlation coefficient − 0.67, p < 0.001). The TAPSE/PASP ratio improved from 0.23 [0.18; 0.29] to 0.33 [0.26; 0.46] mm/mmHg, p < 0.0001, following BPA, and from 0.20 [0.15;0.27] to 0.35 [0.21;0.41] mm/mmHg, p = 0.0007 following PEA, indicating enhanced RV to pulmonary artery coupling. Conclusion: In patients with CTEPH, the echocardiographic TAPSE/PASP ratio as a measure of RV-PA coupling correlates well with invasively measured pulmonary vascular resistance. The TAPSE/PASP ratio improved after BPA or PEA treatments suggesting a potential use for monitoring patient outcomes. Further prospective studies are warranted to establish the prognostic value of the TAPSE/PASP ratio and ability to guide treatment decisions.

KW - Balloon pulmonary angioplasty

KW - Echocardiography

KW - Pulmonary circulation

KW - Pulmonary endarterectomy

KW - Right ventricular function

KW - TAPSE/PASP

UR - http://www.scopus.com/inward/record.url?scp=85206247782&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2024.132639

DO - 10.1016/j.ijcard.2024.132639

M3 - Journal article

C2 - 39406312

SN - 0167-5273

VL - 418

SP - 132639

JO - International Journal of Cardiology

JF - International Journal of Cardiology

M1 - 132639

ER -

Right ventricular to pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

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