Key result
Hypertension is linked to ~74% higher odds of impaired RV–PA coupling.
Cohort (n=1,696)
In a community-based middle-aged cohort without overt cardiovascular disease, noninvasive echocardiographic indices of RV–PA coupling (TAPSE/PASP and S′/PASP) strongly correlated with each other and were independently impaired in the presence of older age, obesity, and hypertension.
Noninvasive RV–PA coupling indices merit prospective outcome studies in primary prevention; should not yet alter clinical risk assessment or practice.
Background Right ventricular–pulmonary arterial (RV–PA) coupling reflects the ability of the right ventricle to adapt to arterial afterload and is a strong prognostic marker in cardiopulmonary diseases. Although noninvasive echocardiographic surrogates are increasingly applied, the determinants of RV–PA coupling in individuals without overt cardiovascular disease remain insufficiently characterized. Methods We analyzed participants from with echocardiography and complete data on RV–PA coupling. Two noninvasive methods were used to derive RV–PA coupling: (1) the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) and (2) the ratio of systolic tissue velocity at the tricuspid annulus to PASP (S′/PASP). Of 1, 696 study participants, a total of 668 subjects had complete TAPSE/PASP data and 308 had S′/PASP. Associations with cardiovascular risk factors were assessed using multivariable regression analyses. Results Mean TAPSE/PASP was 0.95 ± 0.26 mm[GN1] /mmHg [MM2] and mean S′/PASP was 0.54 ± 0.15 cm/s/mmHg, with higher values indicating better RV–PA coupling. The two indices correlated strongly (Spearman r = 0.78; p < 0.0001). RV–PA coupling indices decreased with age, with each 10-year increase associated with lower TAPSE/PASP (β −0.022, 95% CI −0.035 to −0.009; p=0.001) and S′/PASP (β −0.017, 95% CI −0.029 to −0.006; p=0.003). Obesity was likewise associated with reduced TAPSE/PASP (β −0.094, 95% CI −0.154 to −0.034; p=0.002) and S′/PASP (β −0.059, 95% CI −0.113 to −0.005; p=0.031), whereas sex showed no independent [GN3] association with either coupling index. In multivariable models[GN4] , hypertension independently increased the odds of TAPSE/PASP below the median (OR 1.74, 95% CI 1.16–2.62; p=0.007), with no corresponding association for S′/PASP. Conclusions In this community-based middle-aged cohort, worse RV–PA coupling (lower TAPSE/PASP and S′/PASP) was independently associated with adverse cardiovascular risk profiles in multivariable models. The strong correlation between the two indices supports their use as practical, noninvasive measures of RV–pulmonary vascular interaction in population studies. Prospective studies are needed to determine their prognostic value.
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Holm et al. (2026) conducted a cohort in Individuals without overt cardiovascular disease (n=1,696). Cardiovascular risk factors (age, obesity, hypertension) vs. Absence of risk factors was evaluated on TAPSE/PASP below the median (worse right ventricular–pulmonary arterial coupling) (OR 1.74, 95% CI 1.16-2.62, p=0.007). Hypertension independently increased the odds of worse RV–PA coupling (TAPSE/PASP below the median; OR 1.74, 95% CI 1.16–2.62; p=0.007), while age and obesity also reduced coupling indices.
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