Donato Mele1, Gabriele Pestelli2, Davide Dal Molin3, Vittorio Smarrazzo3, Giovanni Andrea Luisi3, Filippo Trevisan3, Andrea Fiorencis3, Filippo Flamigni3, Roberto Ferrari4. 1. Cardiology Unit and LTTA Centre, University of Ferrara, Cona, Italy. Electronic address: donatomele@libero.it. 2. Cardiology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy; Unità di Ricerca Cardiovascolare, Fondazione Sacco, Forlì, Italy. 3. Cardiology Unit and LTTA Centre, University of Ferrara, Cona, Italy. 4. Cardiology Unit and LTTA Centre, University of Ferrara, Cona, Italy; Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
Abstract
BACKGROUND: In a significant proportion of patients with left-sided heart failure (HF), left ventricular filling pressure (LVFP) may not be estimated using echocardiography, so filling pressure status may remain indeterminate. In these patients, mean right atrial pressure (mRAP) has been suggested as a surrogate of LVFP. The aim of this study was to determine whether high mRAP has prognostic value in patients with HF with indeterminate pressure (IP) and whether mRAP-based reclassification of patients with IP has an impact on outcomes. METHODS: A cohort of 465 patients hospitalized with HF was retrospectively studied and divided into groups with normal pressure (n = 102), high pressure (n = 265), and IP (n = 98). A composite end point of all-cause mortality and HF rehospitalization was evaluated after a median follow-up duration of 2.5 years. RESULTS: There were 282 events in the entire population (53 in the normal pressure group, 173 in the high pressure group, and 56 in the IP group; P = .047). High mRAP was independently associated with outcome only in patients with IP (hazard ratio, 2.72; 95% CI, 1.25-5.9; P = .012). Evaluation of LVFP after mRAP-based reclassification of patients with IP resulted in higher risk stratification capability than current recommendations alone (log-rank χ2 = 15.057 vs 8.148). CONCLUSIONS: In patients with inconclusive determination of LVFP, echocardiographic estimation of mRAP is associated with outcomes. This finding corroborates previous observation of mRAP as a surrogate marker of elevated LVFP in left-sided HF and suggests its use in clinical practice.
BACKGROUND: In a significant proportion of patients with left-sided heart failure (HF), left ventricular filling pressure (LVFP) may not be estimated using echocardiography, so filling pressure status may remain indeterminate. In these patients, mean right atrial pressure (mRAP) has been suggested as a surrogate of LVFP. The aim of this study was to determine whether high mRAP has prognostic value in patients with HF with indeterminate pressure (IP) and whether mRAP-based reclassification of patients with IP has an impact on outcomes. METHODS: A cohort of 465 patients hospitalized with HF was retrospectively studied and divided into groups with normal pressure (n = 102), high pressure (n = 265), and IP (n = 98). A composite end point of all-cause mortality and HF rehospitalization was evaluated after a median follow-up duration of 2.5 years. RESULTS: There were 282 events in the entire population (53 in the normal pressure group, 173 in the high pressure group, and 56 in the IP group; P = .047). High mRAP was independently associated with outcome only in patients with IP (hazard ratio, 2.72; 95% CI, 1.25-5.9; P = .012). Evaluation of LVFP after mRAP-based reclassification of patients with IP resulted in higher risk stratification capability than current recommendations alone (log-rank χ2 = 15.057 vs 8.148). CONCLUSIONS: In patients with inconclusive determination of LVFP, echocardiographic estimation of mRAP is associated with outcomes. This finding corroborates previous observation of mRAP as a surrogate marker of elevated LVFP in left-sided HF and suggests its use in clinical practice.
Authors: Alexander C Egbe; Heidi M Connolly; Patricia A Pellikka; Jason H Anderson; William R Miranda Journal: Circ Cardiovasc Imaging Date: 2022-09-20 Impact factor: 8.589
Authors: Hong Meng; Wu Song; Sheng Liu; David Hsi; Lin-Yuan Wan; Hui Li; Shan-Shan Zheng; Zhi-Wei Wang; Rong Ren; Wei-Xian Yang Journal: Front Cardiovasc Med Date: 2021-11-25