Invasive Hemodynamic Predictors of Outcomes in Rheumatic Heart Disease With Echocardiographic RV-PA Uncoupling: A...

Rheumatic heart disease (RHD) is frequently complicated by pulmonary hypertension (PH) and right ventricular (RV) dysfunction. However, the prognostic significance of invasive hemodynamic parameters obtained at index right heart catheterization (RHC) in adults with RHD and echocardiographic RV-pulmonary artery (PA) uncoupling remains incompletely defined. We evaluated their associations with all-cause mortality and a composite adverse clinical outcome. We conducted a single-center retrospective cohort study of a clinically selected group of adults with RHD and echocardiographic RV-PA uncoupling who underwent index RHC for invasive hemodynamic assessment and pre-intervention risk stratification. Parsimonious multivariable logistic regression models were used to examine adjusted associations between selected invasive hemodynamic variables and study outcomes during the available hospital-record observation period. Among 56 patients, 14 (25.0%) died during the available hospital-record observation period after the index RHC, and 23 (41.1%) experienced the composite adverse clinical outcome. In parsimonious multivariable analysis, higher pulmonary vascular resistance (PVR) remained associated with all-cause mortality after adjustment (OR 1.573, 95% CI 1.012-2.447; p = 0.044), whereas lower RV fractional area change (FAC) (OR 0.885, 95% CI 0.814-0.962; p = 0.004) and lower right ventricular stroke work index (RVSWI) (OR 0.819, 95% CI 0.670-1.000; p = 0.020) remained associated with the composite adverse clinical outcome. All patients met hemodynamic criteria for combined pre- and post-capillary pulmonary hypertension. In adults with RHD and echocardiographic RV-PA uncoupling who underwent clinically indicated invasive evaluation, higher PVR was associated with mortality, whereas lower FAC and lower RVSWI were associated with the composite adverse clinical outcome. These findings should be interpreted as exploratory associations derived from a clinically selected cohort and warrant confirmation in larger prospective studies.