Echocardiographic Measure of Right Ventricular-pulmonary Arterial Coupling Predicts Survival in Lung Cancer

Science and Research

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.