Prognostic Importance of Right Ventricular-Vascular Uncoupling in Acute Decompensated Heart Failure With Preserved Ejection Fraction. (November 2020)

• Record Type: Journal Article
• Authors: Nakagawa, Akito; Yasumura, Yoshio; Yoshida, Chikako; Okumura, Takahiro; Tateishi, Jun; Yoshida, Junichi; Abe, Haruhiko; Tamaki, Shunsuke; Yano, Masamichi; Hayashi, Takaharu; Nakagawa, Yusuke; Yamada, Takahisa; Nakatani, Daisaku; Hikoso, Shungo; Sakata, Yasushi
• Is Part Of: Circulation. Volume 13:Number 11(2020)
• Publication Date: 2020-11
• Subjects: atrial fibrillation -- heart failure -- hypertension, pulmonary -- prognosis -- ventricular function, right; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.120.011430
• Languages: English
• ISSNs: 1941-9651

Abstract

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. Abstract : Supplemental Digital Content is available in the text.