Application of an Echocardiographic Index to Characterize Right Ventricular–Pulmonary Arterial Coupling in Heart Failure

Figures

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  Figure 1. Evaluation of right ventricular (RV)–pulmonary arterial (PA) coupling and schematic representation of RV–PA uncoupling. (A) RV–PA uncoupling, the maladaptation between RV contractility and afterload. (B) Pressure–volume relationship of RV. Pulmonary artery end‐systolic elasticity (Ea) was gauged as the ratio of end‐systolic pressure to stroke volume, and RV end‐systolic elasticity (Ees) is expressed as the slope of the tangent between the theoretical maximum pressure (Pmax) produced by the RV and end‐systolic pressure–volume relation (ESPVR). Loop a (yellow) represents normal RV–PA coupling, Loop b (green) represents RV–PA coupling with normal adaptation of the RV to increased afterload, and Loop c (blue) represents RV–PA coupling during RV decompensation. Ees decreased from Ring b to Ring c. EDPVR, end‐diastolic pressure–volume relation; EDV, end‐diastolic volume; ESV, end‐systolic volume.

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  Figure 2. Application of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) in patients with HF. Cpc‐PH, combined pre‐ and post‐capillary pulmonary hypertension; CRT, cardiac resynchronization therapy; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVAD, left ventricular assist device; PH, pulmonary hypertension; RV, right ventricular.

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  Figure 3. An example of a patient with HF. (A) M‐mode trace in the apical four‐chamber view sowing tricuspid annular plane systolic excursion (TAPSE = 17.3 mm). (B) Peak tricuspid regurgitation velocity (3.41 m/s) by continuous‐wave Doppler. (C) Subcostal view, inferior vena cava (IVC) diameter >2.1 cm. (D) M‐mode trace in the subcostal view sowing IVC collapses <50%. The pulmonary artery systolic pressure (PASP) was estimated to be 61.5 mmHg based on the measured data, TAPSE/PASP = 0.28.