Role of Right Ventricular-Pulmonary Arterial Coupling Measured by Echocardiography in Predicting Right Ventricular Dysfunction after Cardiac Surgery

Background: The tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is an indirect estimate of right ventricular-pulmonary arterial (RV-PA) coupling that has been shown to correlate with invasive measures. We aimed to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PASP) as a measure for RV-PA coupling to predict the development of RV dysfunction after cardiac surgery. Methods: This prospective study was conducted on 100 patients with ischemic heart disease and undergoing cardiac surgery (coronary artery bypass graft (CABG)) with normal preoperative right ventricular function, classified according to RV function outcomes into 2 groups: Normal RV group (65 patients) and RV dysfunction group (35 patients). All cases underwent per and postoperative transthoracic echocardiography. Results: By using receiver operating characteristic curve analysis, pre-operative TAPSE/PASP ratio could significantly predict the RV dysfunction (P < 0.001), at cutoff point of >0.58, with AUC of 94%, 88.6% sensitivity, and 89.2% specificity. Post-operative TAPSE/PASP Ratio could significantly predict the RV dysfunction (P < 0.001), at cutoff point of >0.39, with AUC of 84%, 100% sensitivity, and 76.9% specificity. Pre-operative TAPSE/PASP ratio could significantly predict mortality (P < 0.001), at cutoff point of ≤0.52, with AUC of 84%, 56.1% sensitivity, and 100% specificity. Post-operative TAPSE/PASP ratio could significantly predict mortality (P < 0.001), at cutoff point of ≤0.36, with AUC of 71%, 100% sensitivity, and 76.9% specificity. Conclusion: The TAPSE/PASP ratio is an excellent tool for CABG patients for its ability to detect and predict the development of RV dysfunction after cardiac surgery, along with the prediction of mortality in post-operative CABG patients.