Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15‐year prospective longitudinal trajectories in survivors

Santiago‐Vacas, Evelyn; Lupón, Josep; Gavidia-Bovadilla, Giovana; Gual-Capllonch, Francisco; Antonio, Marta de; Domingo, Mar; Núñez, Julio; Zamora, Elisabet; Teis, Albert; Moliner, Pedro; Codina, Pau; Santesmases, Javier; Bayés‐Genís, Antoni

doi:10.1002/ejhf.1862

Cited by 24 publications

(26 citation statements)

References 24 publications

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“…Besides a potential RV–afterload effect described above, the study by Santiago‐Vacas et al . also clearly demonstrates the importance of AF in the development and/or maintenance of RVD in HF 7 . This finding is consistent with prior studies focusing on RVD in patients with HF 3–6,10 .…”

Section: Figuresupporting

confidence: 91%

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Right‐sided cardiac disease: no longer the ‘dark side of the heart’

Gorter

Veldhuisen

Dickinson

2020

European J of Heart Fail

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This article refers to 'Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15-year prospective longitudinal trajectories in survivors' by E. Santiago-Vacas et al., published in this issue on pages 1214-1225. Since almost two decades, it is known that right ventricular (RV) function is a major determinant of outcome in almost all cardiovascular diseases. 1,2 For instance, the presence of RV dysfunction (RVD) is independently associated with poor prognosis in heart failure (HF) with reduced ejection fraction (HFrEF) 1,3,4 as well as in HF with preserved ejection fraction (HFpEF). 3-6 The most important determinants of RVD in patients with HF are: (i) afterload mismatch due to pulmonary hypertension (PH) secondary to left heart disease, (ii) oxygen-perfusion mismatch in the setting of coronary artery disease and/or low cardiac output, (iii) biventricular involvement in the same intrinsic myocardial process, and (iv) systolic and diastolic ventricular interdependence because both ventricles share common myocardial muscle fibres, the interventricular septum and one surrounding pericardium. 2 Despite this long-lasting recognition of RVD in HF, there are still no RV-specific therapies available for patients with chronic HF. More insight is needed in both pathophysiological development of RVD and its possible treatment targets, all this to improve prognosis in patients with HF. 2 In addition, the scarce evidence we have so far is based on cross-sectional studies. Longitudinal studies on RVD in HF are therefore clearly welcome. In this issue of the Journal, Santiago-Vacas et al. 7 have done just that. They present the results of a 15-year follow-up study on RVD and PH in patients with HF. Between 2001 and 2017, they included 1557 patients with HF within the entire spectrum of left ventricular ejection fraction, of which 72% had HFrEF, 12% had HF with mid-range ejection fraction (HFmrEF) and 16% had HFpEF. The authors performed echocardiography at baseline, at 1 year and thereafter every 2 years up to 15 years. PH was defined as systolic pulmonary artery pressure (SPAP) ≥40 mmHg and RV function was assessed using the tricuspid annular plane systolic excursion (TAPSE) and RVD was determined as TAPSE <17 mm. They also The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Section: Figuresupporting

confidence: 91%

“…The present study by Santiago‐Vacas et al . suggests that the latter mechanism may play a role, especially because TAPSE/SPAP ratio <0.36 at 1‐year follow‐up was strongly predictive of poor prognosis 7 . Indeed, TAPSE/SPAP ratio <0.36 also identifies HF patients with a pre‐capillary component of PH in HFpEF 10 .…”

Section: Figurementioning

confidence: 99%

Right‐sided cardiac disease: no longer the ‘dark side of the heart’

Gorter

Veldhuisen

Dickinson

2020

European J of Heart Fail

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“…Two-dimensional and Doppler echocardiography (DE) were performed on the basis of current guidelines. TR-PG was calculated from the TR Vmax obtained from continuous-wave Doppler by the simpli ed Bernoulli equation:TR-PG = 4 (TR Vmax) 2 . TR-mPG was obtained by tracing the time-velocity of TR.…”

Section: Echocardiographymentioning

confidence: 99%

“…Peak velocity of tricuspid regurgitation (TR Vmax) and its derived parameters including TR pressure gradient (TR-PG), TR mean pressure gradient (TR-mPG) and estimated mean pulmonary artery pressure (mPAP ECHO ) were also performed in clinical work, but whether sPAP ECHO is superior to other parameters in determining the probability of PH is worth further study. Besides, sPAP ECHO can also provide valuable information in evaluating treatment response and even predicting prognosis [2,3] . But high proportion of overestimation or underestimation of sPAP ECHO still remained [4] .…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Influencing factors of Pulmonary Artery Systolic Pressure estimated by Doppler Echocardiography: Comparsion with Right Heart Catheterization

Tao

et al. 2021

Preprint

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Purpose This study aimed to explore the accuracy and influencing factors of noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) with right heart catheterization (RHC) as reference. Methods A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ± 10% as the boundary. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥ 25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to evaluate the diagnostic efficacy. The influencing factors of sPAPECHO were analyzed by ordered regression analysis. Results sPAPECHO had the greatest correlation coefficient (r = 0.781, P < 0.001) and best diagnostic efficiency (AUC = 0.98) compared with other TR related methods. Bland-Altman analysis demonstrated the bias of sPAPECHO (mean bias = 0.07mmHg, 95% limits of agreement: -32.08 to + 32.22mmHg) was lower than that of TR-PG (mean bias = 5.87mmHg, 95% limits of agreement: -26.46 to + 38.21mmHg). The results of ordered regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32), respectively. Conclusion sPAPECHO was superior than other TR-related methods in screening PH. TR signal quality is vital for accurate assessment of sPAPECHO. For patients with pre-capillary disease, a higher echocardiographic threshold is more suitable for determining the possibility of PH, especially during the initial stage of disease.

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“…Pulmonary hypertension and right ventricular dysfunction are major prognostic markers in HF and valve disease 20–23 . Santiago‐Vacas et al 24 . assessed the long‐term trajectories of systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE) and TAPSE/SPAP ratio in 1557 HF patients.…”

Section: Cardiac Imagingmentioning

confidence: 99%