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Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies

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Abstract

Background

Right ventricular (RV) dysfunction and RV–pulmonary artery (PA) uncoupling are associated with the development of pulmonary congestion during exercise. However, there is limited information regarding the association between these right-sided cardiac parameters and pulmonary congestion in acutely decompensated heart failure (HF).

Methods

We performed an individual patient meta-analysis from four cohort studies of hospitalized patients with HF who had available lung ultrasound (B-lines) data on admission and/or at discharge. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), RV–PA coupling was defined as the ratio of TAPSE to PA systolic pressure (PASP).

Results

Admission and discharge cohort included 319 patients (75.8 ± 10.1 years, 46% women) and 221 patients (77.9 ± 9.0 years, 47% women), respectively. Overall, higher TAPSE was associated with higher ejection fraction, lower PASP, b-type natriuretic peptide and B-line counts. By multivariable analysis, worse RV function or RV–PA coupling was associated with higher B-line counts on admission and at discharge, and with a less reduction in B-line counts from admission to discharge. Higher B-line counts at discharge were associated with a higher risk of the composite of all-cause mortality and/or HF re-hospitalization [adjusted-HR 1.13 (1.09–1.16), p < 0.001]. Furthermore, the absolute risk increase related to high B-line counts at discharge was higher in patients with lower TAPSE.

Conclusions

In patients with acutely decompensated HF, impaired RV function and RV–PA coupling were associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay. Worse prognosis related to residual pulmonary congestion was enhanced in patients with RV dysfunction.

Graphic abstract

TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure.

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Acknowledgements

MK was provided a grant by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (ANR-15-RHUS-0004). PR, NG and KD are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (ANR-15-RHUS-0004) and by the FrenchPIA project “Lorraine Université d’Excellence” (ANR-15-IDEX-04-LUE).

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Authors and Affiliations

  1. INSERM, Centre d’Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France

    Masatake Kobayashi, Kevin Duarte, Olivier Huttin, Patrick Rossignol & Nicolas Girerd

  2. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Luna Gargani

  3. Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy

    Alberto Palazzuoli

  4. Division of Cardiology, University of Perugia, Perugia, Italy

    Giuseppe Ambrosio & Stefano Coiro

  5. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

    Antoni Bayés-Genis & Josep Lupon

  6. Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK

    Pierpaolo Pellicori

  7. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

    Nicola Riccardo Pugliese

  8. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Yogesh N. V. Reddy

  9. Cardiology Division, Regina Montis Regalis Hospital, ASL CN-1, Mondovì, Cuneo, Italy

    Gaetano Ruocco

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  1. Masatake Kobayashi
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  2. Luna Gargani
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  3. Alberto Palazzuoli
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  4. Giuseppe Ambrosio
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Correspondence to Nicolas Girerd.

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Conflict of interest

NG received honoraria from Novartis and Boehringer. NG and PR are supported by the French National Research Agency Fighting Heart Failure (ANR-15-RHU-0004), by the French PIA project Lorraine Université d’Excellence GEENAGE (ANR-15-IDEX-04-LUE) programs, and the Contrat de Plan Etat Région Lorraine and FEDER IT2MP. PR reports grants and personal fees from AstraZeneca, Bayer, CVRx, Fresenius, and Novartis, and personal fees from Grunenthal, Servier, Stealth Peptides, Vifor Fresenius Medical Care Renal Pharma, Idorsia, NovoNordisk, Ablative Solutions, G3P, Corvidia, Relypsa.

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Kobayashi, M., Gargani, L., Palazzuoli, A. et al. Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies. Clin Res Cardiol 110, 1181–1192 (2021). https://doi.org/10.1007/s00392-020-01724-8

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