In Response: “A Viewpoint on the Role of the Right Heart in General Anesthesia”

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Obese patients with chronic obstructive pulmonary disease undergoing general anesthesia. Intervention: RVOT-VTI/PASP assessment vs. TAPSE/PASP.

PN Shivpriya; Rohan Magoon; Neha Gupta; Nitin Choudhary

doi:10.25259/jccc_27_2026

September 25, 2026Journal of Cardiac Critical Care TSSOpen Access

In Response: “A Viewpoint on the Role of the Right Heart in General Anesthesia”

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Key result

The authors propose that the RVOT-VTI/PASP ratio may offer advantages over TAPSE/PASP for assessing right ventricular-pulmonary artery coupling by better representing actual stroke volume.

Key Points

To address clinical correspondence regarding the evaluation of right ventricular-pulmonary artery coupling, airway management, and perioperative hemodynamic risks in vulnerable surgical patients undergoing general anesthesia.
The authors analyzed perioperative clinical and echocardiographic data from a previously published case series of vulnerable patients, including individuals with obesity and chronic obstructive pulmonary disease.
Patients were evaluated using baseline STOP-BANG scores alongside noninvasive echocardiographic metrics of right ventricular function, including tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract velocity time integral (RVOT-VTI) referenced to pulmonary artery systolic pressure (PASP).
Obese patients in the cohort demonstrated a mean STOP-BANG score of 3, with lowest and highest scores of 2 and 6, respectively, predisposing them to intermittent hypoxia and increased pulmonary artery pressures.
Clinically significant bronchospasm at induction was prevented in patients with moderate chronic obstructive pulmonary disease via preoperative optimization, adequate anesthetic depth, and pharmacological pretreatment prior to laryngoscopy.
The ratio of RVOT-VTI to PASP was identified as an advantageous surrogate for right ventricular-pulmonary artery coupling relative to TAPSE/PASP by reflecting full right ventricular ejection and reducing load dependency.

PICO

P

Population

A letter to the editor discussing right ventricular-pulmonary artery coupling assessment in obese patients with chronic obstructive pulmonary disease undergoing general anesthesia.

E

Exposure / Comparator

RVOT-VTI/PASP assessment vs TAPSE/PASP

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Implication

Correspondence reveals clinical considerations for right ventricular-pulmonary artery coupling in vulnerable surgical patients, highlighting noninvasive Doppler imaging for risk assessment.

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Cite This Study

Shivpriya et al. (2026) conducted a letter in Obese patients with chronic obstructive pulmonary disease undergoing general anesthesia. RVOT-VTI/PASP assessment vs. TAPSE/PASP was evaluated. The authors propose that the RVOT-VTI/PASP ratio may offer advantages over TAPSE/PASP for assessing right ventricular-pulmonary artery coupling by better representing actual stroke volume.

synapsesocial.com/papers/6ab9b9047822ec8fc3d91e3b https://doi.org/10.25259/jccc_27_2026

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In Response: “A Viewpoint on the Role of the Right Heart in General Anesthesia”

Key Points

PICO

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Implication

Abstract

Discussion

Cite This Study

In Response: “A Viewpoint on the Role of the Right Heart in General Anesthesia”

Key Points

PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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