Right Ventricular to Pulmonary Circulation Uncoupling Predicts Adverse Outcome in the Heart Failure Patients Cohorts with Highest Left Ventricular Ejection Fraction and Increased Pulmonary Pressure

<bold>Background:</bold> Pulmonary hypertension and especially right ventricle (RV) dysfunction in heart failure (HF) are associated with poor prognosis. It is unknown how right ventricular (RV) to pulmonary circulation (Pc) uncoupling may impact on prognosis across left ventricular ejection fraction (LVEF) phenotypes <bold>Objective:</bold> To evaluate whether RV-PA coupling is associated with survival and hospitalization rate in patients HF associated with PH. <bold>Methods:</bold> We reviewed the charts of 1066 patients diagnosed with HF of any LVEF and PH defined as PAPS≥ 40 mmHg by Doppler analysis. RV to PC uncoupling was assessed by tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. The patients were divided into three LVEF categories according to guidelines suggested cutoff as follows: EF ≥ 50% (HFpEF) , EF≤ 40% (HFrEF) and 49%≥EF ≥41% (HFmrEF). Negative binomial regression method was used to evaluate the association between TAPSE/PASP ratio and death/recurrent admissions. <bold>Results:</bold> Patient population accounted for 187 HFrEF, 137 HFmrEF and 742 HFpEF patients. Average PAPS was 58.3±13.8, 58.4±15.8 and 55.0±14.8 mmHg, respectively. TAPSE/PASP<0.48 was found to be a predictor of increased mortality (p>0.001, HR 0.03 (0.004-0.21) and recurrent hospitalization (p<0.001) only in in HFpEF patients with SPAP>40 <bold>Conclusions:</bold> The analysis of RV-PA coupling across HF cohorts drives the main attention to the subsets of patients with highest LVEF and elevated PASP. This finding appears interesting per se and require a critical discussion on mechanisms and therapeutic insights.