International Journal of Heart Failure

  • 제6권4호
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  • Pages.165-173
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  • 2024
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  • 2636-154X(pISSN)
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  • 2636-1558(eISSN)
대한심부전학회 (The Korean Society of Heart Failure)
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Prognostic Role of RVGLS/PASP Ratio, a New Echocardiographic Parameter of the Right Ventricle-Pulmonary Artery Coupling, in Patients With Acute Heart Failure

  • Jae-Hyeong Park (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Mijoo Kim (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Jin Joo Park (Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jun-Bean Park (Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Goo-Yeong Cho (Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 투고 : 2024.09.03
  • 심사 : 2024.10.16
  • 발행 : 2024.10.31
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초록

Background and Objectives: Few studies have addressed the predictive implications of right ventricular (RV) and pulmonary arterial (PA) coupling as assessed by echocardiography in patients with acute heart failure (AHF). This study aimed to ascertain the prognostic importance of RV-PA coupling in AHF cases and discern any divergence in its prognostic efficacy based on different heart failure (HF) phenotypes. Methods: We evaluated RV-PA coupling by measuring the ratio of right ventricular global longitudinal strain (RVGLS) to pulmonary arterial systolic pressure (PASP), termed the RVGLS/PASP ratio, and assessed its prognostic role using the STrain for Risk Assessment and Therapeutic Strategies in Patients with Acute Heart Failure registry. Results: From an AHF registry of 4312 patients, we analyzed the RVGLS/PASP ratio in 2,865 patients (1,449 men; age, 71.1±13.5 years). At a median follow-up of 35.0 months, 1,199 (41.8%) patients died. Remarkably, PASP (hazard ratio [HR], 1.012; p<0.001), RVGLS (HR, 1.019; p<0.001), and the RVGLS/PASP ratio (HR, 2.426; p<0.001) were statistically significant predictors of all-cause mortality in the univariate analysis. The RVGLS/PASP ratio was a significant predictor of all-cause mortality in all the HF phenotypes, including HF with reduced ejection fraction (HR, 2.124; p=0.002), HF with mildly reduced ejection fraction (HR, 2.733; p=0.021), and HF with preserved ejection fraction (HR, 2.134; p=0.006). Multivariate analysis after adjusting for clinical and echocardiographic variables revealed that the RVGLS/PASP ratio ≤0.32 was associated with a 36% increase in all-cause mortality (HR, 1.365; p<0.001). Conclusions: Impaired RV-PA coupling, defined as an RVGLS/PASP ratio (≤0.32) was associated with an increased risk of mortality in patients with AHF across all HF phenotypes.

키워드

과제정보

We sincerely thank Prof. Ju Mi Lee, MD, PhD, Department of Preventive Medicine, Chungnam National University College of Medicine, for her help with statistical analysis.

참고문헌

  1. Brener MI, Lurz P, Hausleiter J, et al. Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol 2022;79:448-61.
  2. Hsu S, Fang JC, Borlaug BA. Hemodynamics for the heart failure clinician: a state-of-the-art review. J Card Fail 2022;28:133-48.
  3. Vonk Noordegraaf A, Chin KM, Haddad F, et al. Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: an update. Eur Respir J 2019;53:1801900.
  4. Gorter TM, van Veldhuisen DJ, Voors AA, et al. Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2018;19:425-32.
  5. Guazzi M, Dixon D, Labate V, et al. RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes. JACC Cardiovasc Imaging 2017;10:1211-21.
  6. Tello K, Wan J, Dalmer A, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension. Circ Cardiovasc Imaging 2019;12:e009047.
  7. Bok Y, Kim JY, Park JH. Prognostic role of right ventricular-pulmonary artery coupling assessed by TAPSE/PASP ratio in patients with acute heart failure. J Cardiovasc Imaging 2023;31:200-6.
  8. Lee JH, Park JH. Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography. J Cardiovasc Imaging 2018;26:111-24.
  9. Park JH, Park JJ, Park JB, Cho GY. Prognostic value of biventricular strain in risk stratifying in patients with acute heart failure. J Am Heart Assoc 2018;7:e009331.
  10. Shukla M, Park JH, Thomas JD, et al. Prognostic value of right ventricular strain using speckle-tracking echocardiography in pulmonary hypertension: a systematic review and meta-analysis. Can J Cardiol 2018;34:1069-78.
  11. Park JJ, Park JB, Park JH, Cho GY. Global longitudinal strain to predict mortality in patients with acute heart failure. J Am Coll Cardiol 2018;71:1947-57.
  12. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975.
  13. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
  14. Sun BJ, Park JH. Echocardiographic measurement of left atrial strain - a key requirement in clinical practice. Circ J 2021;86:6-13.
  15. Park JH. Two-dimensional echocardiographic assessment of myocardial strain: important echocardiographic parameter readily useful in clinical field. Korean Circ J 2019;49:908-31.
  16. Rako ZA, Kremer N, Yogeswaran A, Richter MJ, Tello K. Adaptive versus maladaptive right ventricular remodelling. ESC Heart Fail 2023;10:762-75.
  17. Trejo-Velasco B, Estevez-Loureiro R, Carrasco-Chinchilla F, et al. Prognostic role of TAPSE to PASP ratio in patients undergoing MitraClip procedure. J Clin Med 2021;10:1006.
  18. Rosenkranz S, Gibbs JS, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiery JL. Left ventricular heart failure and pulmonary hypertension. Eur Heart J 2016;37:942-54.
  19. Park J, Choi HM, Hwang IC, et al. Prognostic implications of mechanical phenotypes in heart failure characterized by 3-chamber strain echocardiography. J Am Heart Assoc 2022;11:e028040.
  20. Iacoviello M, Monitillo F, Citarelli G, et al. Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients. Int J Cardiol 2017;241:318-21.
  21. Guazzi M, Ghio S, Adir Y. Pulmonary hypertension in HFpEF and HFrEF: JACC review topic of the week. J Am Coll Cardiol 2020;76:1102-11.