Patients with elevated global wasted work ≥38 mmHg/% demonstrated RV–PA uncoupling, indicated by lower Ees/Ea (0.47 vs. 0.71) and TAPSE/sPAP ratios (0.21 vs. 0.34).
Does 3D-derived RV global wasted work (GWW) provide complementary prognostic and mechanistic information to TAPSE/sPAP regarding RV-PA uncoupling and clinical outcomes in patients with precapillary pulmonary hypertension?
While TAPSE/sPAP remains a robust prognostic surrogate in precapillary pulmonary hypertension, 3D-derived RV global wasted work provides complementary mechanistic insight into myocardial inefficiency and RV-PA uncoupling.
Absolute Event Rate: 0% vs 0%
ABSTRACT Background Right ventricular–pulmonary arterial (RV–PA) uncoupling is central to prognosis in precapillary pulmonary hypertension (PH). While the tricuspid annular plane systolic excursion tosystolic pulmonary artery pressure (TAPSE/sPAP) ratio is an established bedside surrogate of RV–PA coupling, novel energetic markers such as three‐dimensional (3D)–derived right ventricular (RV) global wasted work (GWW) may provide complementary insight into maladaptive RV remodeling. Objectives To contextualize the prognostic value of RV GWW relative to TAPSE/sPAP and clarify their mechanistic and clinical complementarity. Methods and Results Patients with elevated GWW (≥38 mmHg/%) exhibited evidence of RV–PA uncoupling, including a reduced RV end‐systolic elastance to arterial elastance (E es /E a ) ratio (0.47 0.34–0.73 vs. 0.71 0.50–0.91; p = 0.007) and lower TAPSE/sPAP ratio (0.21 0.18–0.32 vs. 0.34 0.22– 0.45 mm/Hg; p = 0.003) compared with lower GWW. In secondary analyses, a TAPSE/sPAP ratio below the median was associated with increased risk of death or lung transplantation (hazard ratio HR 3.20; 95% CI: 1.45–7.08), remaining significant after adjustment for age and sex (adjusted HR 2.97; 95% CI: 1.27–6.94). Discrimination was modest and comparable for TAPSE/sPAP (C‐statistic 0.63; 95% CI: 0.53–0.73) and GWW (C‐statistic 0.61), with no significant difference between metrics (ΔC = −0.02; p = 0.68). Conclusions TAPSE/sPAP remains a robust and clinically valuable surrogate of macroscopic RV–PA coupling. However, GWW offers complementary information by quantifying myocardial inefficiency related to paradoxical and postsystolic deformation, capturing energetic consequences of afterload mismatch that may not be reflected by displacement‐based indices alone. Integrating energetic and mechanical markers may enable a more granular assessment of RV performance, particularly in intermediate‐risk PH, and warrants evaluation in larger multicenter studies.
Venkateshvaran et al. (Thu,) reported a other. Patients with elevated global wasted work ≥38 mmHg/% demonstrated RV–PA uncoupling, indicated by lower Ees/Ea (0.47 vs. 0.71) and TAPSE/sPAP ratios (0.21 vs. 0.34).
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