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The right ventricle (RV) is a pulsatile pump, the work of which depends on proper hemodynamic coupling with the compliant pulmonary vasculature (PV)(1). Coupling of the RV-PV axis is predicated on the work-energy principle, which mathematically states that a transfer of energy between 2 related structures is equal to the work expended by a force through displacement (1). It is depicted by ventricular pressure-volume loops and calculated as the ratio of ventricular elastance (Ees, contractility) to arterial elastance (Ea, afterload)(1). Optimal RV-PV coupling corresponds to an Ees/Ea ratio between 1.0 and 2.0, with lower values reflecting reduced work-energy relationships and uncoupling of the RV from its pulmonary load (2). However, these elastance comparisons can be assessed only with right-sided heart catheterization(RHC), thus limiting their clinical use in children. Accordingly, surrogates of the Ees/Ea ratio …