Akito Nakagawa1,2, Yoshio Yasumura1, Chikako Yoshida1, Takahiro Okumura1, Jun Tateishi1, Junichi Yoshida1, Haruhiko Abe3, Shunsuke Tamaki4, Masamichi Yano5, Takaharu Hayashi6, Yusuke Nakagawa7, Takahisa Yamada4, Daisaku Nakatani8, Shungo Hikoso8, Yasushi Sakata8. 1. Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan (A.N., Y.Y., C.Y., T.O., J.T., J.Y.). 2. Department of Medical Informatics (A.N.), Osaka University Graduate School of Medicine, Suita, Japan. 3. Cardiovascular Division, National Hospital Organization Osaka National Hospital, Japan (H.A.). 4. Division of Cardiology, Osaka General Medical Center, Japan (S.T., T.Y.). 5. Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan (M.Y.). 6. Division of Cardiology, Osaka Police Hospital, Japan (T.H.). 7. Division of Cardiology, Kawanishi City Hospital, Hyogo, Japan (Y.N.). 8. Department of Cardiovascular Medicine (D.N., S.H., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
BACKGROUND: Recent accumulating evidence reveals that the right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcome in patients with heart failure (HF), RV dysfunction, and pulmonary hypertension. However, the prognostic utility of RV-PA uncoupling in HF with preserved ejection fraction (HFpEF) remains elusive. In this study, we aim to investigate the associations of RV-PA uncoupling with outcomes of HFpEF inpatients. METHODS: We prospectively studied 655 patients, registered in PURSUIT-HFpEF (The Prospective Multicenter Obervational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter observational study of Japanese HFpEF inpatients. We assigned registered patients based on the determined value of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio that can predict primary outcome as an indicator of RV-PA uncoupling. RESULTS: Univariable Cox regression testing revealed that RV-PA uncoupling was associated with the primary endpoint of all-cause death, HF rehospitalization, and cerebrovascular events (hazard ratio [HR] 1.77 [95% CI, 1.34-2.32], P<0.0001) and the secondary endpoints of all-cause death and HF rehospitalization (HR 2.75 [95% CI, 1.77-4.33], P<0.0001, HR 1.63 [95% CI, 1.18-2.26], P=0.0036, respectively). Multivariable analysis also showed that RV-PA uncoupling was significantly associated with primary endpoint and all-cause death independent of age, sex, atrial fibrillation, renal dysfunction, elevated E/e', and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR 1.38 [95% CI, 1.01-1.88], P=0.0413, HR 1.85 [95% CI, 1.14-3.01], P=0.0129, respectively). CONCLUSIONS: Prospective study of a hospitalized cohort revealed that RV-PA uncoupling was independently associated with adverse outcomes in acute decompensated patients with HFpEF. Registration: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414. Unique identifier: UMIN000021831.
BACKGROUND: Recent accumulating evidence reveals that the right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcome in patients with heart failure (HF), RV dysfunction, and pulmonary hypertension. However, the prognostic utility of RV-PA uncoupling in HF with preserved ejection fraction (HFpEF) remains elusive. In this study, we aim to investigate the associations of RV-PA uncoupling with outcomes of HFpEF inpatients. METHODS: We prospectively studied 655 patients, registered in PURSUIT-HFpEF (The Prospective Multicenter Obervational Study of Patients with Heart Failure with Preserved Ejection Fraction), a multicenter observational study of Japanese HFpEF inpatients. We assigned registered patients based on the determined value of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio that can predict primary outcome as an indicator of RV-PA uncoupling. RESULTS: Univariable Cox regression testing revealed that RV-PA uncoupling was associated with the primary endpoint of all-cause death, HF rehospitalization, and cerebrovascular events (hazard ratio [HR] 1.77 [95% CI, 1.34-2.32], P<0.0001) and the secondary endpoints of all-cause death and HF rehospitalization (HR 2.75 [95% CI, 1.77-4.33], P<0.0001, HR 1.63 [95% CI, 1.18-2.26], P=0.0036, respectively). Multivariable analysis also showed that RV-PA uncoupling was significantly associated with primary endpoint and all-cause death independent of age, sex, atrial fibrillation, renal dysfunction, elevated E/e', and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR 1.38 [95% CI, 1.01-1.88], P=0.0413, HR 1.85 [95% CI, 1.14-3.01], P=0.0129, respectively). CONCLUSIONS: Prospective study of a hospitalized cohort revealed that RV-PA uncoupling was independently associated with adverse outcomes in acute decompensated patients with HFpEF. Registration: URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414. Unique identifier: UMIN000021831.
Authors: Olga Vriz; Gruschen Veldman; Luna Gargani; Francesco Ferrara; Paolo Frumento; Michele D'Alto; Antonello D'Andrea; Sarah Aldosari Radaan; Rosangela Cocchia; Alberto Maria Marra; Brigida Ranieri; Andrea Salzano; Anna Agnese Stanziola; Damien Voilliot; Gergely Agoston; Filippo Cademartiri; Antonio Cittadini; Jaroslaw D Kasprzak; Ekkehard Grünig; Francesco Bandera; Marco Guazzi; Lawrence Rudski; Eduardo Bossone Journal: Int J Cardiovasc Imaging Date: 2021-07-05 Impact factor: 2.357
Authors: Blanca Trejo-Velasco; Ignacio Cruz-González; Manuel Barreiro-Pérez; Elena Díaz-Peláez; Pilar García-González; Ana Martín-García; Rocío Eiros; Soraya Merchán-Gómez; Candelas Pérez Del Villar; Oscar Fabregat-Andrés; Francisco Ridocci-Soriano; Pedro L Sánchez Journal: J Clin Med Date: 2022-01-19 Impact factor: 4.241