Prognostic implications of abnormal right ventricular-pulmonary artery coupling assessed by three-dimensional echocardiography in heart failure with preserved ejection fraction
H Seo, K Kim, S Lee, H J Lee, I Cho, G R Hong, J W Ha, C Y ShimAbstract
Background
In advanced stages of heart failure with preserved ejection fraction (HFpEF), right ventricular (RV) function declines, leading to abnormal RV-pulmonary artery (PA) coupling. Current 2D echocardiography primarily assesses longitudinal function, overlooking RV crescentic geometry and 3D myocardial function. We aimed to evaluate the prognostic implications of RV function and abnormal RV-PA coupling using 3D echocardiography in HFpEF patients.
Methods
We prospectively enrolled 229 patients with HFpEF (74.1 ±10.3 years old, 58.5% female) at a single tertiary center between 2021 and 2023. We assessed 3D RV ejection fraction (RVEF), pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and RV-PA coupling indices (3D RVEF/PASP and TAPSE/PASP). The primary outcome was a composite of cardiovascular death and heart failure hospitalization.
Results
During a median follow-up of 23.5 (range: 14.7 – 25.4) months, 34 (14.8%) primary outcomes occurred. Patients with 3D RVEF < 43% and 3D RVEF-PA coupling < 1.39 had a significantly higher incidence of primary outcomes (log-rank p = 0.005 and p < 0.0001, respectively). In multivariable Cox analysis, abnormal RV–PA coupling with 3D RVEF remained independently associated with adverse outcomes (adjusted HR 0.304, 95% CI: 0.104 – 0.884; p = 0.029).
Conclusions
Reduced RVEF and abnormal RV-PA coupling assessed by 3D echocardiography have prognostic significance in HFpEF patients. 3D assessment of RV–PA coupling may provide incremental prognostic information beyond conventional 2D parameters and serve as a potential imaging marker for prognostic assessment in HFpEF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.