Dynamic Changes in Right Ventricular-Pulmonary Arterial Coupling During Acute Heart Failure Hospitalization:...

Right ventricular (RV) - pulmonary arterial (PA) uncoupling is an important predictor of outcomes in heart failure (HF), yet it may change substantially during hospitalization for acute HF. This study sought to investigate the dynamic changes in RV-PA uncoupling during acute HF hospitalization and their prognostic significance. Tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio was measured in consecutive hospitalized acute HF patients using echocardiography on admission and at discharge. TAPSE/PASP <0.36 mm/mmHg was considered as RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission and discharge, RV-PA uncoupling on admission that normalized to RV-PA coupling at discharge (normalized RV-PA uncoupling), and RV-PA uncoupling on admission that persisted at discharge (persistent RV-PA uncoupling). The primary endpoint was all-cause mortality and HF rehospitalization. Out of 490 patients (73.4 ± 11.9 years old), 216 (44.1%) had RV-PA coupling, 123 (25.1%) normalized RV-PA uncoupling, and 151 (30.8%) persistent RV-PA uncoupling. After a mean follow-up of 12.0 ± 2.6 months, 186 (38.0%) patients reached the primary endpoint. Significantly worse event-free survival rate was observed for the persistent RV-PA uncoupling patients (RV-PA coupling: 74.1%, normalized RV-PA uncoupling: 71.5%, persistent RV-PA uncoupling: 37.1%, Log-rank p < 0.001). Persistent RV-PA uncoupling status was independently associated with the primary endpoint (hazard ratio 2.78 [95% CI 1.73-4.44]; p < 0.001), and provided incremental prognostic information over a baseline model and RV-PA uncoupling on admission. In conclusion, in hospitalized acute HF patients, persistence of RV-PA uncoupling at discharge is associated with worse 1-year event-free survival. Clinical Trial Registration: https://www.clinicaltrials.gov/study/NCT05573997.