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Right ventricle-pulmonary artery uncoupling association with worse prognosis in heart failure with reduced ejection fraction – a real-world study
Session:
Sessão de Posters 55 - Congestão, instabilidade e marcadores prognósticos na insuficiência cardíaca avançada
Speaker:
Mauro Moreira
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mauro Moreira; José Luís Ferraro; Inês Bastos Castro; Inês Gomes Campos; Ana Rodrigo Costa; Joel Ponte Monteiro; Inês Almeida; Ana Leal Neto; Adriana Pereira; Patrícia Silva; Aurora Andrade
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Introduction: </span></strong><span style="font-family:"Arial",sans-serif">Right ventricle (RV)–pulmonary artery uncoupling has emerged as a powerful marker of risk in heart failure (HF), and the TAPSE/sPAP ratio offers a simple way to quantify it. However, due to heterogeneous inclusion criteria in previous studies, current real-world data on its prognostic value remain limited in HF with reduced ejection fraction (HFrEF).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods: </span></strong><span style="font-family:"Arial",sans-serif">Single-center retrospective study with consecutive patients with chronic HFrEF from an HF clinic between 2014-2024. Previous diseases, medication, clinical status, biomarkers, electrocardiogram, echocardiogram and cardiac magnetic resonance (CMR) findings were recorded. Patients with pulmonary hypertension (PH) other than group 2 or inaccurate measurement of tricuspid regurgitation jet were excluded. TAPSE/sPAP cut-off was set at 0.36 mm/mmHg. A composite endpoint including unplanned visits for intravenous diuretic; admission for HF; atrial fibrillation; sustained ventricular tachycardia or ventricular fibrillation; appropriate ICD shocks, and death by any cause was assessed over follow-up.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results: </span></strong><span style="font-family:"Arial",sans-serif">We included 174 patients (73.0% male; mean age 61.4±11.3 years-old), ischemic etiology in 36.2%. Median left ventricle ejection fraction (LVEF) of 25.0±10.2%; RV dilatation in 24.7%; fractional area change ≤35% in 35.8%; TAPSE 17.11±3.9mm, and sPAP 40.0±13.6 mmHg. The median follow-up was 3.6±1.1 years. Lower TAPSE/sPAP ratio was associated with worse kidney function (p=0.004) and higher levels of natriuretic peptides (p=0.003). Lower LVEF (p<0.001), worse RV longitudinal and global systolic function (p<0.001 for both), including in CMR (p=0.03), higher E/e’ (p=0.008), and at least moderate aortic stenosis or mitral/tricuspid regurgitation (p=0.018; p<0.001, respectively) was associated with reduction in TAPSE/sPAP ratio. The composite endpoint and admission for HF alone were more prevalent in patients with low TAPSE/sPAP ratio (p=0.014; p=0.029, respectively). After application of logistic regression, TAPSE/sPAP ratio was not an independent predictor of the enpoint, as it was influenced by other RV and PH parameters.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> This study provides evidence for a simple and reliable parameter – TAPSE/sPAP ratio – that is strongly associated with outcomes, as a surrogate marker of RV systolic function and PH.</span></span></span></p>
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