Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure With Preserved...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Heart Failure Research

Background:

• Right ventricular dysfunction (RVD) is a critical factor in heart failure with preserved ejection fraction (HFpEF).
• Accurate prognostic markers for RVD in HFpEF are essential for risk stratification.
• Existing methods may not fully capture the complexity of RVD in HFpEF.

Purpose of the Study:

• To develop and validate a progressive RVD staging system for HFpEF.
• To evaluate the prognostic impact of combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio with functional tricuspid regurgitation (TR) severity.
• To assess the association of this RVD staging system with mortality in HFpEF patients.

Main Methods:

• Prospective study of 1355 HFpEF patients, with a final sample of 884 after excluding those with unmeasurable PASP.
• Patients categorized into four stages based on TAPSE/PASP ratio (≥0.36 vs <0.36) and TR severity (significant vs none).
• One-year all-cause mortality was assessed and analyzed across the RVD stages.

Main Results:

• A graded association was observed between RVD stages and mortality rates (15.8% to 45.4%).
• Stages 3 and 4, characterized by a lower TAPSE/PASP ratio and/or significant TR, were independently associated with increased mortality risk (HR 1.82 and 2.26, respectively).
• The proposed RVD staging system demonstrated significant prognostic value.

Conclusions:

• The integrated RVD staging system, combining TAPSE/PASP and TR, offers a comprehensive prognostic tool for HFpEF.
• This system provides a widely available and effective method for risk stratification in HFpEF patients.
• Further validation of this staging system in diverse HFpEF populations is warranted.