Right ventricle-pulmonary artery uncoupling in heart failure with reduced ejection fraction: a key prognosis determinant
M Moreira, J Luis Ferraro, I Bastos Castro, I Gomes Campos, A Rodrigo Costa, J Ponte Monteiro, I Almeida, A Leal Neto, A Pereira, P Silva, A AndradeAbstract
Introduction
Right ventricle (RV)–pulmonary artery uncoupling has emerged as a powerful marker of risk in heart failure (HF), and the TAPSE/sPAP ratio offers a simple way to quantify it. However, due to heterogeneous inclusion criteria in previous studies, current real-world data on its prognostic value remain limited in HF with reduced ejection fraction (HFrEF).
Methods
Single-center retrospective study with consecutive patients with chronic HFrEF from an HF clinic between 2014-2024. Previous diseases, medication, clinical status, biomarkers, electrocardiogram, echocardiogram and cardiac magnetic resonance (CMR) findings were recorded. Patients with pulmonary hypertension (PH) other than group 2 or inaccurate measurement of tricuspid regurgitation jet were excluded. TAPSE/sPAP cut-off was set at 0.36 mm/mmHg. A composite endpoint including unplanned visits for intravenous diuretic; admission for HF; atrial fibrillation; sustained ventricular tachycardia or ventricular fibrillation; appropriate ICD shocks, and death by any cause was assessed over follow-up.
Results
We included 174 patients (73.0% male; mean age 61.4±11.3 years-old), ischemic etiology in 36.2%. Median left ventricle ejection fraction (LVEF) of 25.0±10.2%; RV dilatation in 24.7%; fractional area change ≤35% in 35.8%; TAPSE 17.11±3.9mm, and sPAP 40.0±13.6 mmHg. The median follow-up was 3.6±1.1 years. Lower TAPSE/sPAP ratio was associated with worse kidney function (p=0.004) and higher levels of natriuretic peptides (p=0.003). Lower LVEF (p<0.001), worse RV longitudinal and global systolic function (p<0.001 for both), including in CMR (p=0.03), higher E/e’ (p=0.008), and at least moderate aortic stenosis or mitral/tricuspid regurgitation (p=0.018; p<0.001, respectively) was associated with reduction in TAPSE/sPAP ratio. The composite endpoint and admission for HF alone were more prevalent in patients with low TAPSE/sPAP ratio (p=0.014; p=0.029, respectively). After application of logistic regression, TAPSE/sPAP ratio was not an independent predictor of the enpoint, as it was influenced by other RV and PH parameters.
Conclusion
This study provides evidence for a simple and reliable parameter – TAPSE/sPAP ratio – a surrogate marker of RV systolic function and PH that is strongly associated with outcomes in HFrEF.