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The following is a summary of “Prognostic value of non-invasive right ventricle-pulmonary artery coupling in patients with pulmonary hypertension associated with left heart disease,” published in the April 2025 issue of the Journal of Cardiothoracic Surgery by Dou et al. 

This study aimed to evaluate the prognostic significance of non-invasive right ventricle–pulmonary artery coupling in patients with pulmonary hypertension associated with left heart disease (PH-LHD) and to identify key clinical factors associated with adverse outcomes.

A total of 362 patients diagnosed with PH-LHD were enrolled. Plasma N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels were measured using enzyme-linked immunosorbent assay (ELISA). Routine echocardiographic assessments were conducted, and right heart function was evaluated by calculating the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) and S’/PASP ratios were calculated. Based on TAPSE/PASP values, patients were stratified into two groups: mild uncoupling and moderate-to-severe uncoupling. Participants were followed for 3 to 15 months, with clinical events, including all-cause mortality, heart failure rehospitalization, and stroke, recorded. Multivariate Cox proportional hazards regression and Kaplan-Meier survival analyses were performed to assess the prognostic value of TAPSE/PASP.

Patients in the moderate-to-severe uncoupling group had significantly higher proportions of males; individuals with a history of smoking, valvular heart disease, diabetes mellitus, or prior stroke; and elevated levels of PASP, right ventricular diameter (RVD), left ventricular diameter (LVD), left ventricular end-diastolic dimension (LVED), and log-transformed NT-proBNP compared to those in the mild uncoupling group (P < 0.05 for all). Conversely, the moderate-to-severe group exhibited lower TAPSE, S’, S’/PASP ratio, and left ventricular ejection fraction (LVEF) values compared to the mild uncoupling group (P < 0.05 for all).

Multivariate Cox regression analysis identified TAPSE/PASP ([HR] = 0.150; 95% [CI]: 0.023–0.968; P = 0.046) as an independent protective factor against adverse clinical events. In contrast, LVED (HR = 1.301; 95% CI: 1.004–1.059; P = 0.024) and log (NT-proBNP) (HR = 1.870; 95% CI: 1.304–2.682; P = 0.001) were found to be independent risk factors for clinical event recurrence. Kaplan-Meier survival analysis further demonstrated that patients in the mild uncoupling group had significantly better overall survival compared to those in the moderate-to-severe uncoupling group (Log-Rank P = 0.024).

In conclusion, the TAPSE/PASP ratio serves as an important non-invasive prognostic marker in patients with PH-LHD. Incorporating RV-PA coupling assessment into clinical practice may improve risk stratification and management strategies for this patient population.

Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-025-03420-y