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Comment & Response
January 9, 2019

Right Ventricular–Pulmonary Artery Coupling—Let’s Not Lose the Forest for the Trees—Reply

Author Affiliations
  • 1Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
JAMA Cardiol. Published online January 9, 2019. doi:10.1001/jamacardio.2018.4485

In Reply We thank Mehmood for his insightful letter regarding our recent article.1 We agree fully that there is an urgent need for clinicians to proactively assess for right ventricular (RV) underperformance in at-risk patients, for an integrated multimodality approach to assessing RV–pulmonary artery (PA) coupling, and for robust imaging technologies and workflow solutions to facilitate routine quantification of RV function. Indeed, our finding of a nearly 3-fold increase in RV dysfunction prevalence among persons free of clinical heart failure across increasing risk categories (based on American Heart Association/American College of Cardiology Heart Failure Stages) highlights the importance of a high index of suspicion for RV dysfunction in at-risk patients. The prognostic importance of impairments in RV function and RV-PA coupling in these heart failure–free persons further emphasizes their importance.