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Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism

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Abstract

During acute pulmonary embolism (PE) a compensatory increase in right ventricular (RV) contractility is required to match increased afterload to maintain right ventricular-pulmonary arterial (RV-PA) coupling. The aim of this study was to assess the prognostic utility of RV-PA decoupling in acute PE. We assessed the association between measures of transthoracic echocardiography (TTE)-derived RV-PA coupling including tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) and right ventricular fractional area change (FAC)/RVSP as well as stroke volume index (SVI)/RVSP (a measure of pulmonary artery capacitance) with adverse PE-related events (in-hospital PE-related mortality or cardiopulmonary decompensation) using logistic regression analysis. In 820 normotensive patients TTE-derived markers of RV-PA coupling were associated with PE-related adverse events. For each 0.1 mm/mmHg decrease in TAPSE/RVSP the odds of an adverse event increased by 2.5-fold [adjusted OR (aOR) 2.49, 95% confidence interval (CI) 1.46–4.24, p = 0.001], for every 0.1%/mmHg decrease in FAC/RVSP the odds of an adverse event increased by 1.4-fold (aOR 1.42, CI 1.09–1.86, p = 0.010), and for every 0.1 mL/mmHg m2 decrease in SVI/RVSP the odds of an event increased by 2.75-fold (aOR 2.78, CI 1.72–4.50, p < 0.001). In multivariable analysis, TAPSE/RVSP and SVI/RVSP were independent of other risk stratification methods including computed tomography-derived right ventricular dysfunction (RVD), the Bova score, and subjective assessment of TTE-derived RVD. In patients with normotensive acute PE, TTE-derived measures of RV-PA coupling are associated with adverse in-hospital PE-related events and provide incremental value in the risk assessment beyond computed tomography-derived RVD, the Bova score, or subjective TTE-derived RVD.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Omid Kiamanesh and Graeme Prosperi-Porta have equal authorship to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Omid Kiamanesh & Nowell Fine

  2. Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada

    Omid Kiamanesh, Nowell Fine & Jason Weatherald

  3. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Graeme Prosperi-Porta

  4. University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada

    Graeme Prosperi-Porta

  5. Division of Respirology, Department of Medicine, University of Calgary, Calgary, AB, Canada

    Lea Harper, Doug Helmersen & Jason Weatherald

  6. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada

    Kevin Solverson, Paul Boiteau & André Ferland

  7. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-114 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2G3, Canada

    Jason Weatherald

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  1. Omid Kiamanesh
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by OK, KS, GPP, and JW. The first draft of the manuscript was written by OK and GPP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jason Weatherald.

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Kiamanesh, O., Prosperi-Porta, G., Harper, L. et al. Ventricular-arterial decoupling is associated with in-hospital adverse events in normotensive pulmonary embolism. Int J Cardiovasc Imaging 38, 2655–2665 (2022). https://doi.org/10.1007/s10554-022-02677-x

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