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Lower TAPSE/PAPs and RV FW LS/PAPs ratios are associated with adverse in-hospital events in patients undergoing cardiac surgery. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 2, 2026

Right ventricle-pulmonary artery coupling and adverse events after cardiac surgery

Key Result

Lower TAPSE/PAPs and RV FW LS/PAPs ratios were linked to adverse in-hospital events in patients undergoing cardiac surgery, indicating potential for early risk identification.

Key Points

To assess the prognostic significance of RV-PA coupling in patients with coronary artery disease and valvular disease undergoing cardiac surgery.
Included 55 patients with varying heart conditions undergoing different types of surgery.
Preoperative and postoperative echocardiographic assessments were conducted using Echo-Doppler.
Non-invasive measures of RV-PA coupling were calculated using TAPSE/PAPs and RVFWLS/PAPs ratios.
Patients were categorized based on the occurrence of in-hospital adverse events and echocardiographic outcomes were compared.
Significant postoperative decrease in left ventricle ejection fraction and right ventricular systolic function was observed.
Patients with in-hospital adverse events showed lower echocardiographic parameters but were not statistically significant compared to those without adverse events.
RV-PA coupling was significantly reduced postoperatively, suggesting impairment in heart function after surgery.

Structured PICO

Does baseline echocardiographic assessment of RV-PA coupling predict in-hospital adverse events in patients undergoing cardiac surgery?

Population

55 patients with coronary artery disease (CAD) and severe valvular disease undergoing cardiac surgery (20 coronary artery bypass grafting, 4 mitral valve replacement, 6 aortic valve replacement, and 25 combined surgery).

Intervention

Echocardiographic assessment of right ventricular-pulmonary artery (RV-PA) coupling (TAPSE/PAPs and RVFWLS/PAPs ratios) preoperatively and on postoperative day 4-7.

Outcome

In-hospital adverse events (composite of new onset of arrhythmias, acute or worsening HF, acute coronary syndrome, and in-hospital death).composite

Cardiac surgery is associated with a significant early postoperative decline in RV-PA coupling, though baseline coupling parameters did not significantly predict in-hospital adverse events in this small cohort.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Right ventricular–pulmonary artery coupling (RV-PA coupling) refers to the relationship between RV contractility and RV afterload. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload, resulting in RV dysfunction and right heart failure. Purpose Our study aimed to evaluate the prognostic value of RV-PA coupling in patients with coronary artery disease (CAD) and severe valvular disease undergoing cardiac surgery. Methods Study population included 55 patients of whom 20 with CAD undergoing coronary artery bypass grafting (CABG), 4 mitral valve replacement (MVR), 6 aortic valve replacement (AVR) and 25 combined surgery. Echo-Doppler assessment was realized according to EACVI recommendations, preoperatively and on postoperative day 4-7. A comprehensive assessment of RV systolic function was performed (Fig.1). TAPSE, RVs', RV global longitudinal strain (RV GS) and RV free wall global longitudinal strain (RV FWLS) were evaluated. TAPSE/PAPs ratio and RVFWLS/PAPs ratio were calculated to assess non-invasively RV-PA coupling. Study population was then divided into two subgroups according to presence or absence of in-hospital adverse events such as new onset of arrhythmias, acute or worsening HF, acute coronary syndrome and in-hospital death; baseline echocardiographic parameters of the two subgroups were retrospectively compared. Continuous normally distributed variables were compared by using the Student t-test. A probability value 0.05 was considered statistically significant. Analyses were performed with SPSS. Results The comparison of post-operative versus baseline echocardiographic parameters showed statistically significant decrease of left ventricle ejection fraction (LVEF: 54.42±7.20 vs 56.80±7.88, p-value:0.005), LV global longitudinal strain (GLS) (12.79±3.02 vs 17.12±4.35, p-value:0.006) and right ventricular systolic function evaluated by TAPSE (14.67±3.16 vs 21.16±3.53, p-value0.001), RVs’ (8.95±1.53 vs 13.25±2.75, p-value0.001), RV GS (14.16±2.79 vs 18.86±5.01, p-value:0.002) and RV FW LS (13.81±5.06 vs 22.23±6.98, p-value 0.001), reduced TR Vmax (2.43±0.45 vs 2.59±0.59, p-value:0.214) and PAPs (29.84±7.33 vs 32.18±11.46, p-value:0.092), and statistically significant decrease of TAPSE/PAPS ratio (0.52±0.18 vs 0.71±0.26, p-value 0.001) and RV FW LS/PAPs ratio (0.52±0.20 vs 0.87±0.58, p-value:0.011). The comparison of two subgroups revealed that patients with in-hospital adverse events had lower values of TAPSE (20.47±3.06 vs 21.50±3.73, p-value:0.327), RVs’ (12.11±1.69 vs 12.60±3.10 , p-value:0.663), TAPSE/PAPs ratio (0 .70± 0.12 vs 0.72 ± 0.30, p-value:0.810) and RVFWLS/PAPs ratio (0.73±0.12 vs 0.87± 0.58 , p-value:0.560). Conclusions Accurate non invasively evaluation of RV-PA coupling could serve as valuable clinical tool for early identification of high-risk patients, delaying disease progression, guiding treatment, and improving prognosis.Assessment of RV systolic function

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