The ventricular-vascular coupling ratio (Ees/Ea) derived from pressure alone is a strong independent predictor of adverse outcomes in children with pulmonary arterial hypertension (PAH), according to a new study published in Open Heart. It could, therefore, be used as a powerful prognostic tool.

Ventricular-vascular coupling is the ratio between the right ventricle’s contractile state (Ees) and its afterload (Ea). To assess the prognostic capacity of Ees/Ea derived using right ventricular (RV) pressure in children with PAH, a team of researchers led by Kendall Hunter, PhD, retrospectively reviewed 130 children with PAH who underwent right heart catheterization.

They estimated maximum RV isovolumic pressure and end-systolic pressure using 2 single-beat methods. They then used these methods with an estimate of end-systolic pressure to compute ventricular-vascular coupling from pressure alone. 

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Patients were divided into 2 groups: those with idiopathic or hereditary PAH and those with associated PAH. The researchers then assessed the hemodynamic data, clinical functional class, and clinical worsening outcomes of the patients. 

The results showed that in patients with idiopathic or hereditary PAH, both of the single-beat methods used by the researchers were independently associated with time to a hard event, which was defined as either death, transplantation, initiation of prostanoid therapy and hospitalization for atrial septostomy, or Pott’s shunt.

Neither of the 2 methods were associated with the time to a soft event. Soft events included functional class worsening, a syncopal event, hospitalization due to a proportional hazard-related event, and hemoptysis.

In patients with associated PAH, neither of the methods were associated with the time to a soft or hard event. 

“The data presented show that Ees/Ea is a powerful tool that provides insight to both ventricular and vascular function that can be used in management and treatment of children with PAH,” the researchers concluded.


Dufva MJ, Ivy D, Campbell K, et al. Ventricular-vascular coupling is predictive of adverse clinical outcome in paediatric pulmonary arterial hypertension. Open Heart. 2021;8(2):e001611. doi:10.1136/openhrt-2021-001611