{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T15:39:41Z","timestamp":1770824381308,"version":"3.50.1"},"reference-count":3,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Right ventricular\u2013pulmonary arterial (RV\u2013PA) uncoupling is central to prognosis in precapillary pulmonary hypertension (PH). While the tricuspid annular plane systolic excursion tosystolic pulmonary artery pressure (TAPSE\/sPAP) ratio is an established bedside surrogate of RV\u2013PA coupling, novel energetic markers such as three\u2010dimensional (3D)\u2013derived right ventricular (RV) global wasted work (GWW) may provide complementary insight into maladaptive RV remodeling.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To contextualize the prognostic value of RV GWW relative to TAPSE\/sPAP and clarify their mechanistic and clinical complementarity.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Patients with elevated GWW (\u226538\u00a0mmHg\/%) exhibited evidence of RV\u2013PA uncoupling, including a reduced RV end\u2010systolic elastance to arterial elastance (E\n es<\/jats:sub>\n \/E\n a<\/jats:sub>\n ) ratio (0.47 [0.34\u20130.73] vs. 0.71 [0.50\u20130.91];\n p<\/jats:italic>\n = 0.007) and lower TAPSE\/sPAP ratio (0.21 [0.18\u20130.32] vs. 0.34 [0.22\u2013 0.45] mm\/Hg;\n p<\/jats:italic>\n = 0.003) compared with lower GWW. In secondary analyses, a TAPSE\/sPAP ratio below the median was associated with increased risk of death or lung transplantation (hazard ratio [HR] 3.20; 95% CI: 1.45\u20137.08), remaining significant after adjustment for age and sex (adjusted HR 2.97; 95% CI: 1.27\u20136.94). Discrimination was modest and comparable for TAPSE\/sPAP (C\u2010statistic 0.63; 95% CI: 0.53\u20130.73) and GWW (C\u2010statistic 0.61), with no significant difference between metrics (\u0394C = \u22120.02;\n p<\/jats:italic>\n = 0.68).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n TAPSE\/sPAP remains a robust and clinically valuable surrogate of macroscopic RV\u2013PA coupling. However, GWW offers complementary information by quantifying myocardial inefficiency related to paradoxical and postsystolic deformation, capturing energetic consequences of afterload mismatch that may not be reflected by displacement\u2010based indices alone. Integrating energetic and mechanical markers may enable a more granular assessment of RV performance, particularly in intermediate\u2010risk PH, and warrants evaluation in larger multicenter studies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/echo.70389","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:01:46Z","timestamp":1767794506000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Linking Energetic Inefficiency to Ventriculoarterial Uncoupling in Pulmonary Hypertension"],"prefix":"10.1111","volume":"43","author":[{"given":"Ashwin","family":"Venkateshvaran","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology Ume\u00e5 University Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Lindow","sequence":"additional","affiliation":[{"name":"Department of Medicine Research and Development, Region Kronoberg, V\u00e4xj\u00f6 Central Hospital V\u00e4xj\u00f6 Sweden"},{"name":"Department of Clinical Sciences Lund Pulmonary Medicine, Allergology, and Palliative Medicine, Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raluca","family":"Jumatate","sequence":"additional","affiliation":[{"name":"Department of Medicine Central Hospital Kristianstad, Region Sk\u00e5ne, Lund University Lund Sweden"},{"name":"Cardiology, Department of Clinical Sciences Lund University Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Institute For Clinical Data Management Semmelweis University Budapest Hungary"},{"name":"Department of Experimental Cardiology and Surgical Techniques Semmelweis University Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Ingvarsson","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences Lund University Lund Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University hospital Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology Ume\u00e5 University Ume\u00e5 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Werther","family":"Evaldsson","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical Sciences Lund University Lund Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University hospital Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"e_1_2_2_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.70344"},{"issue":"1","key":"e_1_2_2_3_1","first-page":"1","article-title":"Challenges and Opportunities in Assessing Right Ventricular Structure and Function: A Roadmap for Standardization, Clinical Implementation and Research","volume":"23","author":"Kov\u00e1cs A.","year":"2025","journal-title":"Nature Reviews Cardiology"},{"key":"e_1_2_2_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14030668"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70389","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70389","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:50:46Z","timestamp":1769601046000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":3,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/echo.70389"],"URL":"https:\/\/doi.org\/10.1111\/echo.70389","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70389"}}