Abstract
Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1: TAPSE/PASP ≥ 0.36 without significant TR; stage 2: TAPSE/PASP ≥ 0.36 with significant TR; stage 3: TAPSE/PASP < 0.36 without significant TR; and stage 4: TAPSE/PASP < 0.36 with significant TR. By the 1 year follow-up, 207 (23.4%) patients had died. We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001). After multivariable adjustment, and compared to stage 1, stages 3 and 4 were independently associated with mortality risk (HR: 1.8219; 95% CI 1.308–2.538; p < 0.001 and HR = 2.2632; 95% CI 1.540–3.325; p < 0.001, respectively). A RVD staging system, integrating TAPSE/PASP and TR, provides a comprehensive and widely available tool for risk stratification in HFpEF.
Highlights
Heart failure with preserved ejection fraction (HFpEF) is becoming the dominant form of heart failure (HF)
We sought to evaluate the prognostic impact of a progressive Right ventricular dysfunction (RVD) staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity
We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001)
Summary
Heart failure with preserved ejection fraction (HFpEF) is becoming the dominant form of heart failure (HF). Functional tricuspid regurgitation (TR) is commonly the final consequence of right-side pressure overload and RV–PA uncoupling, leading to further RV remodeling and dysfunction, perpetuating the process [4,5,12]. All of these RV dysfunction (RVD) parameters have been shown to be strongly related to outcomes in HFpEF in isolation [8,10,13,14,15], but little is known of the prognostic value of the interplay between them. Our aim was to create a comprehensive noninvasive staging system of progressive RVD features in HFpEF, integrating both TAPSE/PASP and TR, and to assess the impact of these stages on survival after a hospitalization for acute HF
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