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Different right ventricular dysfunction and pulmonary coupling in acute heart failure according to the left
Alberto Palazzuoli1, Alessandra Cartocci2, Filippo Pirrotta1
1Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte Hospital University of Siena Italy, Italy.
Progress in Cardiovascular Diseases
|August 3, 2023
Summary
Right ventricular (RV) adaptation and RV-pulmonary artery coupling differ in acute heart failure (AHF) based on left ventricular ejection fraction (LVEF). Prognostic markers vary between preserved and reduced LVEF in AHF patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Right ventricular (RV) dysfunction and pulmonary uncoupling are linked to poor outcomes in heart failure.
- Limited data exist on RV adaptation across different left ventricular ejection fraction (EF) levels, especially in acute heart failure (AHF).
Purpose of the Study:
- To analyze RV function and RV-pulmonary artery coupling in AHF patients with reduced EF (AHFrEF) versus preserved EF (AHFpEF).
Main Methods:
- A multi-center observational study of 380 AHF patients (235 AHFrEF, 145 AHFpEF).
- Echocardiographic measurements included pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), S' wave velocity, and RV end-diastolic diameter (RVEDD).
- TAPSE/PASP and S'/PASP ratios were calculated as surrogates of RV-pulmonary arterial coupling.
Main Results:
- Higher PASP, RVEDD, and lower TAPSE, S' wave, TAPSE/PASP, and S'/PASP ratios were associated with poor outcomes.
- In AHFpEF, S'/PASP ratios >0.22 indicated a protective effect.
- In AHFrEF, TAPSE <16 mm, RVEDD >21 mm, and TAPSE/PASP <0.49 were related to adverse outcomes.
Conclusions:
- RV adaptation and RV-pulmonary coupling strategies differ in AHF based on LVEF.
- S' wave and S'/PASP are key prognostic indicators in AHFpEF.
- Reduced TAPSE and TAPSE/PASP are significant predictors of adverse outcomes in AHFrEF.
Keywords:
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