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 patients with lung cancer.

Objectives

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 examined using Doppler, strain, and three-dimensional echocardiography before starting therapy. Of the included patients, 41% were women, and the median age was 68 years (interquartile range, 61-74 yr). Prediction of one-year overall survival was assessed using univariable analysis followed by multivariate Cox regression, receiver operating characteristic curves and Kaplan-Meier analyses.

Results

Median sPAP was within the limits of normal (31 mm Hg [interquartile range, 26-36 mm Hg]); 30% of the patients had sPAP ≥ 35 mm Hg. 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 ratio (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 receiver operating characteristic curve-derived RV GLS:sPAP cutoff to predict survival was -0.54%/mm Hg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS:sPAP > -0.54%/mm Hg) 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 ratio as an echocardiographic measure of RV-arterial coupling adds to prognostication by UICC status in non-small cell lung cancer. Clinical trial registered with www.clinicaltrials.gov (NCT04467333).