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
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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":"{\"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}","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
摘要
理由：据报道，肺动脉高压的超声心动图指标可以预测肺癌患者的生存率降低。目的：我们验证了这可能与右心室(RV)-收缩期肺动脉压（sPAP）耦合受损有关的假设。方法：这项前瞻性观察研究纳入了220例非小细胞肺癌（NSCLC）门诊患者，在开始治疗前通过多普勒、应变和三维超声心动图检查。在纳入的患者中，41%为女性，中位年龄为68岁[61,74]。采用单变量分析、多变量Cox回归、受试者工作特征（ROC）曲线和Kaplan-Meier分析评估患者一年总生存期的预测。结果：中位sPAP在正常范围内（31 mmHg [26,36]）；30%的患者sPAP≥35 mmHg。在单变量分析中，一年总生存率与右心室收缩功能和肺动脉高压发生率相关。在多因素Cox回归中，只有RV整体纵向应变(GLS)/sPAP（风险比[HR]: 8.76[95%可信区间（CI）： 1.24-61.82], P = 0.03）、1秒用力呼气量（HR: 0.98 [95% CI: 0.96-1.00], P = 0.03）和东部肿瘤合作组工作状态< 2 （HR: 0.34 [95% CI: 0.17-0.68], P = 0.003）独立预测生存。预测生存率的最佳ROC曲线衍生的RV GLS/sPAP截止值为-0.54%/mmHg。在国际癌症控制联盟（UICC） 4期患者中，RV-动脉偶联受损（RV GLS/sPAP > -0.54%/mmHg）患者的生存率低于维持RV-动脉偶联的患者（HR: 2.89 [95% CI: 1.55-5.42], P < 0.001）；后一亚组与UICC 3期患者的生存率相似（HR: 0.65 [95% CI: 0.35-1.20], P = 0.17）。结论：RV GLS/sPAP作为一种超声心动图测量RV-动脉耦合的方法，可以通过UICC状态来预测NSCLC患者的预后。
Echocardiographic Measure of Right Ventricular-pulmonary Arterial Coupling Predicts Survival in Lung Cancer.
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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