Abstract
Abstract Background Right ventricular-pulmonary arterial (RV-PA) coupling is a powerful prognosticator in heart failure (HF). However, acute HF treatment may improve the connection of RV to the PA circulation for some patients. Whether the dynamic changes of RV-PA coupling during hospitalization for acute HF carry a prognostic value remains unexplored. Methods TAPSE/PASP was measured in all consecutive patients hospitalized for acute HF using echocardiography within 24 hours from admission and within 24 hours before discharge. TAPSE/PASP ≥0.36 mm/Hg was considered RV-PA coupling and TAPSE/PASP <0.36 mm/Hg RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission, RV-PA uncoupling on admission that improved to RV-PA coupling on discharge (Improved RV-PA uncoupling), and RV-PA uncoupling on admission without improvement on discharge (Non-improved RV-PA uncoupling). All-cause death and HF hospitalization was the composite primary endpoint. Results Of the 401 patients 185 (46.1%) had RV-PA coupling on admission, 93 (23.2%) had Improved RV-PA uncoupling, and 123 (30.7%) had Non-improved RV-PA uncoupling. After a median follow up of 6 months (interquartile range, 2.3-9.8), 141 (35.2%) patients reached the primary endpoint. Patients with Non-improved RV-PA uncoupling showed higher cumulative event rates compared to the other 2 groups (RV-PA coupling: 24.3%, Improved RV-PA uncoupling: 24.7%, Non-improved RV-PA uncoupling: 59.3%, Log-rank p< 0.001) (Figure 1). In multivariate cox-regression analysis Non-improved RV-PA uncoupling was independently associated with the composite outcome (hazard ratio 2.54 [95% CI, 1.45–4.46]; p =0.001), and provided incremental prognostic information over a baseline clinical and echocardiographic model and RV-PA uncoupling on admission (Figure 2). Conclusion Absence of improvement in RV-PA uncoupling in response to acute HF treatment is associated with worst event-free survival and may indicate advanced RV failure and PA remodeling not amenable to medical management. Figure 1: Event-free survival Figure 2: Incremental prognostic value
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call