{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:09:25Z","timestamp":1792843765938,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,5,18]]},"abstract":"\n Background<\/jats:title>\n \n Although right ventricular (\n RV<\/jats:styled-content>\n ) to pulmonary arterial (\n RV<\/jats:styled-content>\n \u2010\n PA<\/jats:styled-content>\n ) coupling is considered the gold standard in assessing\n RV<\/jats:styled-content>\n dysfunction, its ability to predict clinically significant outcomes is poorly understood. We assessed the ability of\n RV<\/jats:styled-content>\n \u2010\n PA<\/jats:styled-content>\n coupling, determined by the ratio of multi\u2010beat (\n MB<\/jats:styled-content>\n ) end\u2010systolic elastance (Ees) to effective arterial elastance (Ea), to predict clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Twenty\u2010six subjects with\n pulmonary arterial hypertension (PAH)<\/jats:styled-content>\n underwent same\u2010day cardiac magnetic resonance imaging, right heart catheterization, and\n RV<\/jats:styled-content>\n pressure\u2010volume assessment with\n MB<\/jats:styled-content>\n determination of Ees\/Ea.\n RV<\/jats:styled-content>\n ejection fraction (\n RVEF<\/jats:styled-content>\n ), stroke volume\/end\u2010systolic volume, and single beat\u2010estimated Ees\/Ea were also determined. Patients were treated with standard therapies and followed prospectively until they met criteria of clinical worsening (\n CW<\/jats:styled-content>\n ), as defined by \u226510% decline in 6\u2010minute walk distance, worsening World Health Organization (\n WHO<\/jats:styled-content>\n ) functional class,\n PAH<\/jats:styled-content>\n therapy escalation,\n RV<\/jats:styled-content>\n failure hospitalization, or transplant\/death. Subjects were 57\u00b114\u00a0years, largely\n WHO<\/jats:styled-content>\n class\n III<\/jats:styled-content>\n (50%) at enrollment, with preserved average\n RV<\/jats:styled-content>\n ejection fraction (\n RVEF<\/jats:styled-content>\n ) (47\u00b111%). Mean follow\u2010up was 3.2\u00b11.3\u00a0years. Sixteen (62%) subjects met\n CW<\/jats:styled-content>\n criteria.\n MB<\/jats:styled-content>\n Ees\/Ea was significantly lower in\n CW<\/jats:styled-content>\n subjects (0.7\u00b10.5 versus 1.3\u00b10.8,\n P<\/jats:italic>\n =0.02). The optimal\n MB<\/jats:styled-content>\n Ees\/Ea cut\u2010point predictive of\n CW<\/jats:styled-content>\n was 0.65, defined by\n ROC<\/jats:styled-content>\n (\n AUC<\/jats:styled-content>\n 0.78,\n P<\/jats:italic>\n =0.01).\n MB<\/jats:styled-content>\n Ees\/Ea below this cut\u2010point was significantly associated with time to\n CW<\/jats:styled-content>\n (\n hazard ratio<\/jats:styled-content>\n 5.1,\n P<\/jats:italic>\n =0.001).\n MB<\/jats:styled-content>\n Ees\/Ea remained predictive of outcomes following multivariate adjustment for timing of\n PAH<\/jats:styled-content>\n diagnosis and\n PAH<\/jats:styled-content>\n diagnosis subtype.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n RV<\/jats:styled-content>\n \u2010\n PA<\/jats:styled-content>\n coupling as measured by\n MB<\/jats:styled-content>\n Ees\/Ea has prognostic significance in human\n PAH<\/jats:styled-content>\n , even in a cohort with preserved\n RVEF<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.016031","type":"journal-article","created":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T16:15:43Z","timestamp":1588954543000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":87,"title":["Multi\u2010Beat Right Ventricular\u2010Arterial Coupling Predicts Clinical Worsening in Pulmonary Arterial Hypertension"],"prefix":"10.1161","volume":"9","author":[{"given":"Steven","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine E.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A.","family":"Houston","sequence":"additional","affiliation":[{"name":"Department of Medicine Medical University of South Carolina Charleston SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Wand","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Sato","sequence":"additional","affiliation":[{"name":"First Department of Medicine Hokkaido University Hospital Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Kolb","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Mathai","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Kass","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Hassoun","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Damico","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Tedford","sequence":"additional","affiliation":[{"name":"Department of Medicine Medical University of South Carolina Charleston SC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvx145"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)43030-4"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1461"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.32.3.314"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.44.3.309"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/22.12.864"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.01023.2002"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000008"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022082"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.033147"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201906-1195LE"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201203-0480OC"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.4103\/2045-8932.109920"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201806-1160ST"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01900-2018"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.047"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005512"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01913-2018"},{"issue":"55","key":"e_1_3_1_20_2","first-page":"1520","article-title":"Estimation 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