Integrating Resistant and Pulsatile Right Ventricular Load Improves Severity Assessment in Heart Failure Patients

Area of Science:

• Cardiology
• Pulmonary Hypertension
• Heart Failure Research

Background:

• Current pulmonary hypertension definitions by ESC/ERS focus solely on pulmonary vascular resistance (PVR), neglecting pulsatile load (pulmonary artery compliance [PAC]).
• Pulsatile load is recognized as a critical factor in right ventricular (RV) afterload and overall cardiovascular health.

Purpose of the Study:

• To compare the severity grading of RV afterload using the current ESC/ERS pulmonary hypertension definition versus a novel RV afterload score.
• To investigate the relationship between PVR and PAC in heart failure patients.
• To assess the prognostic value of the novel RV afterload score.

Main Methods:

• A cohort of 328 patients with reduced left ventricular ejection fraction (<50%) undergoing right heart catheterization was analyzed.
• A points-based system was used to quantify RV afterload based on separate PVR and PAC measurements.
• The primary endpoint was a composite of all-cause mortality or left ventricular assist device implantation.

Main Results:

• The novel RV afterload score demonstrated superior severity stratification compared to ESC/ERS phenotypes, with significant differences in RV function, cardiac index, and pulmonary artery wedge pressure.
• The RV afterload score showed significant prognostic value (P = 0.010), with a high score associated with a 4.42-fold increased risk of the primary endpoint.
• A hyperbolic relationship between PVR and PAC was observed, enabling the definition of PVR zones with distinct afterload characteristics.

Conclusions:

• A novel RV afterload score has been developed, offering improved severity grading and prognostication for pulmonary hypertension in heart failure patients.
• The defined PVR intervals based on the PVR-PAC relationship may aid in personalized therapy and future clinical trials.
• This score addresses the limitations of current definitions by incorporating both resistive and pulsatile components of RV afterload.