The cardio-hepatic syndrome and right ventricular dysfunction in heart failure with mildly reduced ejection fraction

Right ventricular dysfunction (RVD) is common in patients with heart failure (HF) and reduced ejection fraction and may lead to cardio-hepatic syndrome (CHS). The present study investigates the prevalence and prognostic impact of CHS and RVD in heart failure with mildly reduced ejection fraction (HFmrEF).

Data investigating the prognostic impact of CHS and RVD in patients with HFmrEF are scarce.

Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of CHS (≥2 increased cholestasis parameters), as well as RVD assessed by tricuspid plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and right ventricular fractional area change (RV FAC) was investigated regarding the risk of all-cause mortality and HF-related rehospitalization at 30 months.

794 HFmrEF patients were included of whom 20.3% suffered from CHS and up to 20.9% from RVD. At 30 months, the CHS was not associated the risk of 30-months all-cause mortality (adjusted hazard ratio (aHR)=1.316; 95% confidence interval (CI) 0.990-1.751; p=0.059). In contrast, RVD assessed by the TAPSE (< 17mm; aHR=1.482; 95% CI 1.126-1.951; p=0.005) and the TAPSE/PASP (<0.36mm/mmHg; aHR=1.566; 95% CI 1.092-2.245; p=0.015) predicted the risk of the primary endpoint. Finally, neither the CHS, nor RVD were associated with the risk of HF-related rehospitalization.

CHS and RVD are prevalent in 20% of patients with HFmrEF, whereas the TAPSE or TASPE/PASP were independently associated with increased all-cause mortality. In HFmrEF patients, RVD may carry greater prognostic significance as compared to the CHS.