Prognostic Importance of Right Ventricular-Vascular Uncoupling in Acute Decompensated Heart Failure With Preserved Ejection Fraction

Circ Cardiovasc Imaging. 2020 Nov;13(11):e011430. doi: 10.1161/CIRCIMAGING.120.011430. Epub 2020 Nov 17.

Abstract

Background: Recent accumulating evidence reveals that the right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcome in patients with heart failure (HF), RV dysfunction, and pulmonary hypertension. However, the prognostic utility of RV-PA uncoupling in HF with preserved ejection fraction (HFpEF) remains elusive. In this study, we aim to investigate the associations of RV-PA uncoupling with outcomes of HFpEF inpatients.

Methods: We prospectively studied 655 patients, registered in PURSUIT-HFpEF (The Prospective Multicenter Obervational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter observational study of Japanese HFpEF inpatients. We assigned registered patients based on the determined value of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio that can predict primary outcome as an indicator of RV-PA uncoupling.

Results: Univariable Cox regression testing revealed that RV-PA uncoupling was associated with the primary endpoint of all-cause death, HF rehospitalization, and cerebrovascular events (hazard ratio [HR] 1.77 [95% CI, 1.34-2.32], P<0.0001) and the secondary endpoints of all-cause death and HF rehospitalization (HR 2.75 [95% CI, 1.77-4.33], P<0.0001, HR 1.63 [95% CI, 1.18-2.26], P=0.0036, respectively). Multivariable analysis also showed that RV-PA uncoupling was significantly associated with primary endpoint and all-cause death independent of age, sex, atrial fibrillation, renal dysfunction, elevated E/e', and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR 1.38 [95% CI, 1.01-1.88], P=0.0413, HR 1.85 [95% CI, 1.14-3.01], P=0.0129, respectively).

Conclusions: Prospective study of a hospitalized cohort revealed that RV-PA uncoupling was independently associated with adverse outcomes in acute decompensated patients with HFpEF. Registration: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414. Unique identifier: UMIN000021831.

Keywords: atrial fibrillation; heart failure; hypertension, pulmonary; prognosis; ventricular function, right.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arterial Pressure
  • Female
  • Heart Failure / diagnostic imaging
  • Heart Failure / mortality
  • Heart Failure / physiopathology*
  • Heart Failure / therapy
  • Humans
  • Japan
  • Male
  • Patient Readmission
  • Prognosis
  • Prospective Studies
  • Pulmonary Artery / physiopathology*
  • Risk Assessment
  • Risk Factors
  • Stroke Volume*
  • Tricuspid Valve / physiopathology
  • Ventricular Function, Left*
  • Ventricular Function, Right*

Associated data

  • UMIN-CTR/UMIN000021831