Right ventricle-pulmonary artery uncoupling in heart failure with reduced ejection fraction: a marker of worse clinical status and diuretic requirements
M Moreira, I Bastos Castro, J Luis Ferraro, A Rodrigo Costa, I Gomes Campos, 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 other than group 2 or inaccurate measurement of tricuspid regurgitation jet were excluded. TAPSE/sPAP cut-off was set at 0.36 mm/mmHg. Clinical status assessed by New York Heart Association (NYHA) class and diuretic requirements was compared between groups with high and low TAPSE/sPAP ratio.
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; sPAP 40.0±13.6 mmHg. The median follow-up was 3.6±1.1 years. Lower TAPSE/sPAP ratio was associated with previous admissions for HF (p=0.007); worse NYHA class (p=0.005), worse kidney function (p=0.004); prevalence of cholestasis as indicated by analytical liver tests (p=0.021); higher diuretic requirements (p<0.001), including combined diuretic therapy (p=0.02), higher levels of natriuretic peptides (p=0.003), and levosimendan therapy at 1-year (p=0.02).
Conclusion
This study suggests that TAPSE/sPAP ratio is associated with worse clinical status and higher requirements of isolated or combined diuretic therapy, as well as therapy with levosimendan in HFrEF patients.