Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

https://doi.org/10.4081/monaldi.2020.1269

Authors

  • Gian Marco Rosa Department of Internal Medicine and Medical Specialities, University of Genoa, Italy. https://orcid.org/0000-0003-0809-2301
  • Andreina D'Agostino Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Italy.
  • Stefano Giovinazzo Department of Internal Medicine and Medical Specialities, University of Genoa, Italy. https://orcid.org/0000-0001-8744-6133
  • Giovanni La Malfa Department of Internal Medicine and Medical Specialities, University of Genoa, Italy. https://orcid.org/0000-0002-8197-3175
  • Paolo Fontanive Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Italy. https://orcid.org/0000-0003-4749-3650
  • Mario Miccoli Department of Clinical and Experimental Medicine, University of Pisa, Italy.
  • Frank Lloyd Dini | franklloyddini@gmail.com Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Italy. https://orcid.org/0000-0003-1458-4820

Abstract

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

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Published
2020-05-15
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Section
Cardiology - Original Articles
Keywords:
Echocardiography, heart failure, right ventricle
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How to Cite
Rosa, Gian Marco, Andreina D’Agostino, Stefano Giovinazzo, Giovanni La Malfa, Paolo Fontanive, Mario Miccoli, and Frank Lloyd Dini. 2020. “Echocardiography of Right Ventricular-Arterial Coupling Predicts Survival of Elderly Patients With Heart Failure and Reduced to Mid-Range Ejection Fraction”. Monaldi Archives for Chest Disease 90 (2). https://doi.org/10.4081/monaldi.2020.1269.

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