5037Right ventricular to pulmonary circulation uncoupling is associated with adverse left ventricular cardiac remodeling and worse exercise performance in patients with heart failure

Abstract

Background: In heart failure (HF) syndrome, progressive development of pulmonary hypertension and right ventricular (RV) failure carries a significant neg-ative prognostic value, regardless the degree of the left ventricular (LV) ejection fraction. Purpose: We aimed at performing a comprehensive analysis of HF stageing based on the evaluation of RV contractile state and its coupling with the pulmonary circulation across all ranges of LV systolic reserve. To this purpose we stratified a large cohort of HF patients based on tricuspid annular plane excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) ratio as a recognized measure of RV to pulmonary circulation coupling Material and methods: We prospectively enrolled 157 patients with a diagnosis of HF, irrespective of their LV ejection fraction. A complete echocardiographic evaluation was performed, recording standard images to assess LV systolic, diastolic, and valvular function. We stratified patients by tertile of noninvasive TAPSE/PASP ratio as follows: 1: <0,40 mm/mmHg; 2: 0,41-0,71 mm/mmHg; 3 >0,72 mm/mmHg. Continuous variables were compared across TAPSE/PASP tertiles using one way ANOVA; categorical variables were compared across groups using chi-square tests. Results: The 3 groups had similar baseline characteristics, such as age, hypertension, dyslipidemia and COPD rate. Patients in tertile 1 had a higher NYHA class complaining more frequently of exertional dyspnea, had higher Left atrial volume indexed (64,4±28,1 vs. 49,6±22,7vs. 35,3±12,1; p<0,001), LV mass in-dexed (137,5±39,5 vs. 129,8±31,1 vs. 114,5±20,3; p=0,001) and LVend-diastolic volume indexed (92,9±34,6vs. 86,4±22,5vs. 72,5±24,7; p=0,005)while LVStroke Volume and LV Ejection Fraction were significantly lower (31±11 vs. 39±13 vs. 41±14; p=0,001). The prevalence and severity of both mitral and tricuspid regur-gitation were higher in tertile 1 (p<0,001 and p=0,001, respectively). As to cardiopulmonary data, patients in tertile 1 also exhibited a significantly lower peak VO2 (10,9±3,5 vs. 12,8±3,7 vs. 14,4±4,5; p<0,001) and O2 pulse, whereas they had a higher VE/VCO2 slope(40,6±11,2vs. 32,4±6,4vs. 30,2±5,1; p<0,001) and a more frequent exercise oscillatory ventilation, an independent predictor of sudden cardiac death in HF patients. [Figure Presented] Conclusion: The progressive maladaptive LV remodeling and evolving stages of HF are associated with a parallel RVto-pulmonary circulation (PC) uncoupling as demonstrated by an unfavourable TAPSE/PASP ratio. Therapies that may target the right heart seem a quite unmet need.