Optimal Method for Assessing Right Ventricular to Pulmonary Arterial Coupling in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis

• Published in: The American journal of cardiology 2024-07, Vol.222, p.11-19
• Main Authors: Jani, Vivek P., Strom, Jordan B., Gami, Abhishek, Beussink-Nelson, Lauren, Patel, Ravi, Michos, Erin D., Shah, Sanjiv J., Freed, Benjamin H., Mukherjee, Monica
• Format: Article
• Language: English
• Subjects: Adults; Age; Aged; Aged, 80 and over; Aging; Arteriosclerosis; Atherosclerosis; Atherosclerosis - diagnosis; Atherosclerosis - ethnology; Atherosclerosis - physiopathology; Blood pressure; Brain natriuretic peptide; Cardiomyopathy; Cardiovascular disease; Cardiovascular diseases; Congestive heart failure; Coupling; Diabetes; Doppler effect; Echocardiography; Echocardiography, Doppler - methods; Ethnic factors; Ethnicity; Female; Females; Health risks; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Male; Males; Medical imaging; MESA; Muscle contraction; Natriuretic Peptide, Brain - blood; NT-proBNP; Peptide Fragments - blood; Pulmonary arteries; Pulmonary artery; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; pulmonary artery systolic pressure; right ventricle; Risk factors; Systolic pressure; Ultrasonic imaging; United States - epidemiology; Velocity; Ventricle; Ventricular Function, Right - physiology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.03.043

•Echocardiographic coupling ratios identify occult right-sided cardiac dysfunction in healthy older adults.•Echocardiographic coupling ratios are associated with 6-minute walk distance, N-terminal pro-B-type natriuretic peptide, and Kansas City Cardiomyopathy Questionnaire score.•Across ratios, fractional area change/pulmonary artery systolic pressure best relates to age-related and gender-related functional and geometric changes.•Incorporation of coupling ratios refines prediction of right ventricular dysfunction and pulmonary hypertension. Right ventricular (RV) to pulmonary arterial (PA) coupling describes the ability of the RV to augment contractility in response to increased afterload. Several echocardiographic indexes of RV-PA coupling have been defined; however, the optimal numerator in the coupling ratio is unclear. We sought to establish which of these ratios is best for assessing RV-PA coupling based on their relations with 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in aging adults. In this study of 1,611 Multi-Ethnic Study of Atherosclerosis participants who underwent echocardiography at Exam 6, we evaluated the association between different numerators, including tricuspid annular planar systolic excursion (TAPSE), fractional area change (FAC), RV free wall strain, and tissue Doppler imaging S’ velocity to pulmonary artery systolic pressure (PASP) with 6MWD, NT-proBNP, and KCCQ score, adjusted for socioeconomic and cardiovascular disease risk factors. Our cohort had a mean age of 73 ± 8 years, 54% female, 17% Chinese American, 22% African American, 22% Hispanic, and 39% White participants. The mean ( ± SD) TAPSE/PASP, FAC/PASP, tissue Doppler imaging S’ velocity/PASP, and RV free wall strain:PASP ratios were 0.7 ± 0.2, 1.3 ± 0.3, 0.5 ± 0.1, and 0.8 ± 0.2, respectively. All RV-PA coupling indices decreased with age (p