Prognostic value of echocardiography-based right ventricular-pulmonary artery coupling estimation in acute decompensated heart failure

Abstract Background Right ventricular-pulmonary artery coupling (RV-PA coupling) represents the relationship between RV contractility and RV afterload. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload. This leads to RV dysfunction and right heart failure in the end. The value of RV-PA uncoupling in patients with chronic heart failure with reduced and preserved ejection fraction as a determinant of clinical status and strong predictor of cardiovascular death, rehospitalization for heart failure was demonstrated by literature worldwide. However, there are few studies estimated RV-PA uncoupling prognostic value in patients with acute decompensated heart failure (ADHF) upon admission. Purpose To assess echocardiographic parameter of RV-PA coupling and its prognostic value in patients with ADHF. Methods A single-centre observational study included 171 patients admitted to the city clinical hospital with ADHF (51.5% male, 70 (62;80) years old, arterial hypertension 93%, previous myocardial infarction 39.8%, HF with preserved ejection fraction (HFpEF) 36.8% (n=63), HF with reduced EF (HFrEF) 41.5% (n=71), HF with mid-range EF (HFmrEF) 21.6% (n=37), diabetes 36.8%, NYHA functional class III – 52.1%, class IV – 40.2%, NTproBNP 1683 (830;2944) pg/ml, serum creatinine 105 (86;126.4) µmol/l, eGFR 54.2 (44.1;67.8) ml/min/1.73 m2, potassium 4.5 ± 0.7 mmol/l, echocardiography parameters - left ventricle ejection fraction (LVEF) 44 (30;55)%, pulmonary artery systolic pressure (PASP) 51.2±17.3 mmHg, tricuspid annular plane systolic excursion (TAPSE) 15.4±4.7mm. RV-PA coupling estimated by the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio was evaluated upon admission using two-dimensional echocardiography. TAPSE/PASP < 0.36 mm/mmHg was considered as RV-PA uncoupling. Survival analysis was perfomed using Kaplan-Meier curves. Differences were considered statistically significant when p <0.05. Results A statistically significant impact of RV-PA uncoupling on hospitalization, estimated by echocardiography, for heart failure (HF) and for all-cause hospitalization was revealed. Among patients with RV-PA uncoupling the risk of hospitalization for HF increased by 25% (RR 1.251; 95%CI: 1.020-1.539, p=0.042), and the risk of all-cause hospitalization - by 20-24% (RR 1.240; 95% CI: 1.001-1.537; p=0.049). Hospitalization rates for HF (OR 2.07; 95%CI: 1.02–4.02; p=0.042) and all-cause hospitalization (OR 1.96; 95%CI: 1.00–3.86; p=0.049) were 2 times higher. Conclusion: The identified prognostic value of echocardiography-based RV-PA uncoupling estimation in ADHF regardless of phenotype indicates the advisability of its assessment upon hospitalization. TAPSE/PASP can serve as an important simple tool for risk stratification of patients, optimizing their management and improving the long-term survival of patients.