Right ventricular pulmonary artery uncoupling independently associated with 5 year outcome following AHF hospitalisation

Abstract Background Right ventricular pulmonary artery (RV-PA) uncoupling is associated with poor outcome across a range of conditions, but its role in acute heart failure (AHF) remains incompletely investigated. Purpose To investigate if RV-PA uncoupling is independently associated with mortality following hospitalisation for AHF. Methods 418 patients were recruited. 391/418 (93.5%) had measurable TAPSE and SPAP and were followed up for 5 years to assess for all-cause mortality. Patients were recruited if they displayed signs and symptoms of AHF, had point-of-care brain-natriuretic peptide >100pg/ml and had evidence of HF on TTE. We identified a study-specific cut-off for TAPSE/SPAP of 0.24mm/mmHg on ROC analysis and performed univariate analysis to assess for an association with outcome. 30 covariates encompassing comorbidities, medications, echo parameters and observations were assessed and logistic regression analysis performed including variables associated with outcome. Results Patient average age at presentation was 79 years, 53.3% were male, 55.5% had hypertension, 30.7% had diabetes and 36.8% had CAD with a mean LVEF of 42.6% and BNP of 1363pg/ml. The mean TAPSE was 15.6mm and SPAP of 52.5mmHg. The average TAPSE/SPAP was 0.34mm/mmHg. 252/391 (64.5%) presented with TAPSE/SPAP <0.24mm/mmHg. These individuals were at higher risk of 5-year mortality compared to >0.24mm/mmHg: HR 1.94 (95% CI 1.49-2.54 [p<0.0001]), which persisted when adjusted for significant covariates – HR 1.35 (95% CI 1.02-1.80 [p<0.0395]). Conclusion TAPSE/SPAP ratio is an independent predictor of mortality in patients admitted with AHF. Our cut-off, a lower value than others have suggested in the literature for chronic conditions such as pulmonary hypertension, could identify those at risk of poor outcome in the acute setting. This may offer an exciting therapeutic target and help risk stratify patients. These results should focus the attention of those managing AHF patients onto the RV, pulmonary pressures and their interrelationship. It is time we moved beyond the LVEF.