Right Ventricular-Pulmonary Artery Uncoupling and Strain in Acute Heart Failure

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Right ventricular-pulmonary artery (RV-PA) coupling is vital for risk stratification in chronic heart failure.
• Data on RV-PA coupling in acute heart failure (AHF) are limited.
• Echocardiographic assessment of RV-PA coupling aids in predicting outcomes.

Purpose of the Study:

• To evaluate the prognostic value of RV-PA coupling surrogates in AHF.
• To compare the predictive capabilities of TAPSE/PASP and RV free wall strain/PASP ratios.
• To investigate the performance of these ratios in AHF with reduced vs. preserved ejection fraction.

Main Methods:

• A multicenter observational study of 425 AHF patients.
• Echocardiography measured pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and RV free wall strain.
• TAPSE/PASP and RV free wall strain/PASP ratios were calculated as RV-PA coupling surrogates.

Main Results:

• 197 patients (46.4%) reached the composite endpoint of all-cause death/HF hospitalization at 180 days.
• Both TAPSE/PASP and RV free wall strain/PASP were independent predictors of prognosis after multivariable adjustment.
• RV free wall strain/PASP demonstrated superior discrimination compared to TAPSE/PASP (AUC 0.70 vs. 0.66).
• The superiority of RV free wall strain/PASP was more pronounced in AHF with preserved ejection fraction.

Conclusions:

• RV free wall strain/PASP is a powerful independent predictor of prognosis in AHF.
• RV free wall strain/PASP offers superior prognostic discrimination over TAPSE/PASP, especially in AHF with preserved ejection fraction.
• These findings enhance the understanding of RV-PA coupling in AHF management.