The Role Of Right Ventricle-Arterial Coupling In Acute Pulmonary Embolism With Right Ventricle Dysfunction: A Retrospective Cohort Study.

Background According to current guidelines, the presence of right ventricle dysfunction (RVD) in patients with pulmonary embolism (PE) is a turning point for clinical decision making. Right ventricle-arterial coupling (RVAC) is defined as the capability of the right ventricle to compensate the rise of pulmonary pressures by increasing its contractility. RVAC can easily and quickly be assessed with echocardiography through the ratio between the tricuspid anteroposterior systolic elevation (TAPSE) and the pulmonary arterial systolic pressure (PASp) (TAPSE/PASp) Aim of the current study was to investigate right ventricle-arterial coupling in patients admitted for PE. Methods Consecutive patients admitted in a large tertiary center for PE were retrospectively analyzed, enrolling all subjects with RVD. For each patient we obtained, at the admission: age, sex, body surface area, heart rate, systolic pressure, respiratory frequency and the main echocardiographic findings. We treated the TAPSE/PASp ratio both as continuous and dichotomous variable, adopting a cutoff of 0.32, derived from current literature on pulmonary arterial hypertension. BOVA score was treated as a dichotomous variable, subdividing patients in low-intermediate risk (BOVA≤4, stages I-II) and high risk (BOVA>4, stage III). Continuous variables were related with linear regression analysis and compared with t-test and ANOVA. Results we finally obtained a sample of 109 consecutive subjects. Patients in BOVA stage III showed, when compared with the other subjects: a significant reduction of TAPSE, TAPSE/PASp, significantly lower telediastolic and telesystolic volumes in left ventricle and a significant reduction of stroke volume and VTILVOT. Patients with a TAPSE/PASp ratio ≤0.32 showed: a higher RV/LV ratio, a higher prevalence of paradoxical septum movement, a significant reduction of TAPSE, a significantly reduced telediastolic and telesistolic volumes and a significant reduction of stroke volume and VTILVOT. Conclusion Patients with PE and RVD with a low TAPSE/PASp ratio show significantly worse echocardiographic parameters, suggesting that an alteration of RVAC could have strong implications in the ventricular interdependency and could be suggestive of a worse haemodynamic status. Patients in stage BOVA III show a worse RVAC and, consequently, worse LV performances thus representing the group at highest risk of hemodynamic instabilisation.