Zvonimir A Rako, Michael Cekay, Athiththan Yogeswaran, Selin Yildiz, Philipp F Arndt, Nils Kremer, Simon Schaefer, Patrick Janetzko, Bruno Brito da Rocha, Chris M Mummert, Johanna K Franken, Henrik Soethe, Hannah F Werner, Rio Dumitrascu, Friedrich Grimminger, Hossein A Ghofrani, Soni S Pullamsetti, Werner Seeger, Robert Naeije, Rajkumar Savai, Bastian Eul, Khodr Tello
{"title":"Echocardiographic Measure of Right Ventricular-pulmonary Arterial Coupling Predicts Survival in Lung Cancer.","authors":"Zvonimir A Rako, Michael Cekay, Athiththan Yogeswaran, Selin Yildiz, Philipp F Arndt, Nils Kremer, Simon Schaefer, Patrick Janetzko, Bruno Brito da Rocha, Chris M Mummert, Johanna K Franken, Henrik Soethe, Hannah F Werner, Rio Dumitrascu, Friedrich Grimminger, Hossein A Ghofrani, Soni S Pullamsetti, Werner Seeger, Robert Naeije, Rajkumar Savai, Bastian Eul, Khodr Tello","doi":"10.1513/AnnalsATS.202409-949OC","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale: </strong>Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer.</p><p><strong>Objective: </strong>We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling.</p><p><strong>Methods: </strong>This prospective observational study included 220 outpatients with non-small cell lung cancer (NSCLC) examined by Doppler, strain, and 3-dimensional echocardiography before starting therapy. Of the included patients, 41% were female and the median age was 68 years [61, 74]. Prediction of one-year overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses.</p><p><strong>Results: </strong>Median sPAP was within the limits of normal (31 mmHg [26, 36]); 30% of the patients had sPAP ≥ 35 mmHg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (hazard ratio [HR]: 8.76 [95% confidence interval (CI): 1.24-61.82], P = 0.03), forced expiratory volume in 1 second (HR: 0.98 [95% CI: 0.96-1.00], P = 0.03) and Eastern Cooperative Oncology Group performance status < 2 (HR: 0.34 [95% CI: 0.17-0.68], P = 0.003) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was -0.54%/mmHg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP > -0.54%/mmHg) had worse survival than those with maintained RV-arterial coupling (HR: 2.89 [95% CI: 1.55-5.42], P < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.65 [95% CI: 0.35-1.20], P = 0.17).</p><p><strong>Conclusions: </strong>RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the American Thoracic Society","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1513/AnnalsATS.202409-949OC","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale: Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer.
Objective: We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling.
Methods: This prospective observational study included 220 outpatients with non-small cell lung cancer (NSCLC) examined by Doppler, strain, and 3-dimensional echocardiography before starting therapy. Of the included patients, 41% were female and the median age was 68 years [61, 74]. Prediction of one-year overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses.
Results: Median sPAP was within the limits of normal (31 mmHg [26, 36]); 30% of the patients had sPAP ≥ 35 mmHg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (hazard ratio [HR]: 8.76 [95% confidence interval (CI): 1.24-61.82], P = 0.03), forced expiratory volume in 1 second (HR: 0.98 [95% CI: 0.96-1.00], P = 0.03) and Eastern Cooperative Oncology Group performance status < 2 (HR: 0.34 [95% CI: 0.17-0.68], P = 0.003) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was -0.54%/mmHg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP > -0.54%/mmHg) had worse survival than those with maintained RV-arterial coupling (HR: 2.89 [95% CI: 1.55-5.42], P < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.65 [95% CI: 0.35-1.20], P = 0.17).
Conclusions: RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.
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