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Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension

Frühe echokardiographische Beurteilung der rechtsventrikulären Anpassungsfähigkeit an die Herzlast nach sequenzieller Kombinationstherapie der pulmonalarteriellen Hypertonie

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Abstract

Background

Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy.

Methods

A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed.

Results

A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p < 0.001). Right atrial pressure (8 mm Hg [5–10]; 5 mm Hg [3–8], p < 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p < 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N‑terminal pro-B-type natriuretic peptide (r = −0.524, p < 0.001), tricuspid regurgitation velocity (r = −0.749, p < 0.001), right atrial area (r = −0.298, p = 0.037), and right atrial pressure (r = −0.463, p = 0.001).

Conclusion

In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.

Zusammenfassung

Hintergrund

Ziel der Arbeit war es, mit der Verwendung des Quotienten (TAPSE/PASP) der systolischen Exkursion der Trikuspidalringebene (TAPSE) zum pulmonalarteriellen systolischen Druck (PASP) – als Index für die rechtsventrikuläre Anpassungsfähigkeit an die Herzlast – früh auftretende Veränderungen der kontraktilen Funktion des rechten Herzens bei Betroffenen mit pulmonalarterieller Hypertonie (PAH) der Gruppe 1 nach sequenzieller PAH-spezifischer Kombinationstherapie zu beurteilen.

Methoden

In die vorliegende Studie wurden 49 Betroffene mit PAH der Gruppe 1 und 31 Teilnehmende als Kontrollen einbezogen. Dabei wurden die klinischen und echokardiographischen Ausgangsdaten der Kontroll- und der PAH-Gruppe verglichen. Anschließend wurden die klinischen und echokardiographischen Daten der PAH-Betroffenen vor der Behandlung und 6 Monate nach PAH-spezifischer Therapie ausgewertet.

Ergebnisse

Bei PAH-Betroffenen fand sich beim Follow-up nach 6 Monaten ein signifikanter Anstieg beim TAPSE/PASP-Quotienten (0,25 ± 0,14; 0,33 ± 0,16; p < 0,001). Der rechtsatriale Druck (8 mm Hg [5–10]; 5 mm Hg [3–8]; p < 0,001) und PASP (80,8 ± 30,6 mm Hg; 65,9 ± 25,7 mm Hg; p < 0,001) waren nach sequenzieller PAH-spezifischer Kombinationstherapie signifikant niedriger. Negative Korrelationen wurden festgestellt zwischen dem TAPSE/PASP-Quotienten und dem „N-terminal pro-B-type natriuretic peptide“ (NT-proBNP; r = −0,524; p < 0,001), der trikuspidalen Regurgitationsgeschwindigkeit (r = −0,749; p < 0,001), der rechtsatrialen Fläche (r = −0,298; p = 0,037) und dem rechtsatrialen Druck (r = −0,463; p = 0,001).

Schlussfolgerung

Bei Betroffenen mit PAH der Gruppe 1 war bei der echokardiographischen Beurteilung in einem frühen Behandlungsstadium (nach 6 Monaten) eine signifikante Verbesserung des TAPSE/PASP-Quotienten festzustellen, was ein Zeichen einer rechtsventrikulären Anpassung an die Herzlast darstellt. Vergleichende Studien sind erforderlich, um den Routineeinsatz des TAPSE/PASP-Quotienten in der Risikoabschätzung von PAH-Betroffenen zu beurteilen.

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Acknowledgements

The authors thank all participants in the research process.

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Authors and Affiliations

  1. Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Kadriye Memic Sancar M.D., Mustafa Yildiz M.D., M.D., Serkan Kahraman M.D., Begum Uygur M.D., Umit Bulut M.D., Meltem Tekin M.D., Arda Guler, Nail Guven Serbest M.D., Seda Tukenmez Karakurt, Ahmet Yasar Cizgici M.D. & Mehmet Erturk M.D.

  2. Department of Internal Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey

    Banu Sahin Yildiz M.D.

  3. Department of Cardiovascular Surgery, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey

    Muhammed Bayram M.D.

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Correspondence to Kadriye Memic Sancar M.D..

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Conflict of interest

K.M. Sancar, M. Yildiz, S. Kahraman, B. Uygur, U. Bulut, M. Tekin, A. Guler, N. Guven Serbest, S.T. Karakurt, B.S. Yıldız, A.Y. Cizgici, M. Bayram and M. Erturk declare that they have no competing interests. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional (Ethic Committee of Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital with a number of 2021/26 and date of 23/03/2021) and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Memic Sancar, K., Yildiz, M., Kahraman, S. et al. Early echocardiographic evaluation of right ventricular load adaptability after sequential combination treatment in pulmonary arterial hypertension. Herz 48, 316–324 (2023). https://doi.org/10.1007/s00059-022-05139-1

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