Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

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.

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

“…Echocardiographic techniques are rapidly improving, and several newer methods have been suggested to improve the assessment of specific functions [ 32 ]. In our study, we chose to adopt TAPSE/PASp since this marker is strongly associated with AHF prognosis, and appears to be quite independent from left ventricle pathophysiology [ 33 , 34 ], which can be difficultly assessed in an emergency setting and in the first hours of admission. In fact, transthoracic LVEF evaluation can be affected by several physiological, technical, and clinical issues [ 35 ], and the described inter- and intra- observer variability of LVEF could imply a misclassification of the subjects [ 36 ].…”

H2FPEF score predicts atherosclerosis presence in patients with systemic connective tissue disease

“…While CIMT >0.9 mm is commonly used and easily understood by most clinicians 37 , the impact of age and sex cannot be neglected 38 . Furthermore, CIMT measurements were usually performed at the common carotid artery, however previous studies differed according to measurement side (left side versus right side), measurement wall (far wall versus near wall) and method of combination of single measurements (mean versus mean‐maximum) 39,40 . The use of different ultrasound machines with varying transducer frequencies may also be impactful 39,40 .…”

“…Furthermore, CIMT measurements were usually performed at the common carotid artery, however previous studies differed according to measurement side (left side versus right side), measurement wall (far wall versus near wall) and method of combination of single measurements (mean versus mean‐maximum) 39,40 . The use of different ultrasound machines with varying transducer frequencies may also be impactful 39,40 . Syntax score ≥ 1 is another cut off determinant that could be understood as too low, however, the intention was to identify any presence of atherosclerosis, regardless of its significance.…”

Indicațiile actuale ale combinației terapeutice sacubitril/valsartan în insuficiența cardiacă | [Current indications for sacubitril/valsartan therapeutic combination in heart failure]

“…În cazurile patologice, AG II devine un promotor important al proceselor de hipertrofie şi fibroză la nivel vascular şi cardiac, precum şi în aterogeneză şi aterotromboză. (Gori et al, 2019b;Santas et al, 2020).…”