A team from the department of cardiology at the Wuhan Asia Heart Hospital, China, found a noninvasive method that could evaluate right ventricle function in patients with pulmonary arterial hypertension (PAH) in a quantitative, reliable, and accurate way.

They compared 3 methods—single-beat estimation, the volume method combined with cardiac magnetic resonance, and the pressure–volume loop—currently used in clinical practice to measure the end-systolic elasticity (Ees)/arterial elasticity (Ea) ratio. Despite all methods being able to measure the right ventricle–pulmonary artery coupling Ees/Ea ratio, the volume method combined with cardiac magnetic resonance demonstrated the best performance.

The 3 methods produced distinct results. The Ees/Ea ratio was 2.07±1.01, 2.64±1.48, and 0.72 ± 0.43 when measured by single-beat estimation, pressure–volume loop, and the volume method, respectively. The result of the volume method, but not single-beat estimation and pressure–volume loop, was negatively correlated with N-terminal pro-brain natriuretic peptide (NT-proBNP) values and New York Heart Association classification.

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The statistical significance of the correlation between the Ees/Ea ratio measured by the volume method and NT-proBNP values was further confirmed through regression analysis. “These results were far superior to the invasive data as measured by the right cardiac catheter,” the team wrote in Medicine.

The study enrolled 49 adults with PAH (36 with congenital heart disease-associated PAH, 9 with idiopathic PAH, and 4 with connective tissue disease-associated PAH).

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Both NT-proBNP and the New York Heart Association classification system are widely used for clinical evaluation of right ventricle function in patients with PAH. However, several studies have suggested that heart contractility and afterload, as measured by Ees and Ea, respectively, are also important parameters to consider. Moreover, the Ees/Ea ratio has been identified as an independent predictor of right ventricle function in previous publications.


Dong Y, Li Y, Song L. Evaluation of right ventricular function in patients with pulmonary arterial hypertension by different right ventricular-pulmonary artery coupling methods. Medicine. 2022;101(39). doi:10.1097/MD.0000000000030873