Non‐invasive surrogates for right Ventricular‐Pulmonary arterial coupling: a systematic review and Meta‐Analysis

Right ventricle‐pulmonary artery (RV‐PA) coupling describes the energetic relationship between RV contractility and its afterload. The gold standard for assessment of this relationship requires invasive pressure‐volume (PV) loop measurements. Non‐invasive surrogates of RV‐PA coupling have been developed, such as the echocardiographic tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP), but their performance has not been systematically assessed. We sought to assess performance of TAPSE/PASP ratio compared to PV loop‐defined RV‐PA coupling. A systematic search was conducted. Studies were included if PV loop derived RV‐PA coupling metrics were compared to echocardiographic or magnetic resonance imaging surrogates. We conducted a meta‐analysis of TAPSE/PASP correlation to PV loop‐defined RV‐PA coupling. 1452 studies were identified in the initial search, of which ten met inclusion criteria. Five studies allowed for pooled analysis of TAPSE/PASP to Ees/Ea correlation ( r = 0.52, 95% confidence interval 0.36–0.65). There was moderate heterogeneity across the pooled studies. Despite the common use of Non‐invasive surrogates of RV‐PA coupling, there is only moderate correlation with gold standard measurements. These metrics do not inform on the individual components of RV‐PA coupling, limiting their use in the management of patients with RV dysfunction.