Prognostic impact of right ventricular global wasted work in acute heart failure with right ventricular dysfunction
V Anastasiou, E S Stavropoulou, A N Nikolaidou, E F Fardoulis, E B Baltagianni, T Z Zegkos, T K Karamitsos, G G Giannakoulas, N A M Ajmone-Marsan, J J B Bax, A Z Ziakas, V K KamperidisAbstract
Background
Right-ventricular (RV) dysfunction assessed by TAPSE is a marker of poor prognosis in acute heart failure (HF). However, the role of the novel index of RV global wasted work (GWW) that describes the inefficient RV energy expenditure remains undetermined in such patients.
Purpose
This study sought to explore the prognostic value of RVGWW in acute HF patients with impaired TAPSE.
Methods
Consecutive patients admitted for acute HF were prospectively enrolled and RVGWW was assessed within 24 hours before discharge. For patients with RV dysfunction described as TAPSE ≤17 mm, spline curve analysis was performed to identify the optimal prognostic cut-off value of RVGWW. Patients were followed up for the primary endpoint of all-cause mortality and HF rehospitalization.
Results
Out of 476 patients included in the study (73.4±11.9 years old, 58.6% male), 265 (55.7%) had TAPSE ≤17 mm, and were further divided into 2 groups; those with RVGWW ≤77.3 mmHg/% (n=165) and those with RVGWW >77.3 mmHg/% (n=100) (Picture 1). During a mean follow-up of 12.0±2.5 months, 183 (38.4%) patients reached the primary endpoint. Patients with TAPSE ≤17 mm & RVGWW >77.3 mmHg/% demonstrated the highest percentage of cumulative events (62.0%) compared to patients with TAPSE >17 mm (31.8%) and patients with TAPSE ≤17 mm & RVGWW ≤77.3 mmHg/% (32.7%), with the latter 2 groups sharing similar risk (Log-rank p <0.001) (Picture 2). RVGWW >77.3 mmHg/% was independently associated with the primary endpoint (adjusted HR: 1.90 [95% CI, 1.18–3.08]; p =0.009) and provided incremental prognostic value over clinical, biochemical, and echocardiographic variables, including RV free wall longitudinal strain (Picture 2).
Conclusion
Increased RVGWW could re-stratify the prognosis of acute HF patients with established RV dysfunction. RVGWW >77.3 mmHg/% had incremental additive value over and above clinical, biochemical and echocardiographic biomarkers for predicting worse outcome at long-term follow-up.Picture 1Picture 2