An echocardiographic risk criterion (LAVI > 35 mL/m2 or TAPSE/PASP < 0.40) was associated with increased 3-year risk of adverse clinical events in HF with pcPH (HR 1.97; 95% CI 1.41-2.75; p<0.0001).
Cohort
Yes
Does the echocardiographic risk criterion of LAVI > 35 mL/m2 or TAPSE/PASP < 0.40 predict adverse outcomes in adults with chronic heart failure and post-capillary pulmonary hypertension?
Echocardiographic indices (LAVI and TAPSE/PASP) provide strong, non-invasive prognostic value for adverse outcomes in patients with heart failure and post-capillary pulmonary hypertension, complementing clinical risk scores.
Hazard Ratio: 1.97 (95% CI 1.41–2.75)
p-value: p=<0.0001
Abstract Background Post-capillary pulmonary hypertension (pcPH) is a frequent complication of heart failure (HF), associated with poor outcomes. While right heart catheterization (RHC) is the diagnostic gold standard, echocardiographic indices such as left atrial volume index (LAVI) and the TAPSE/PASP ratio may offer non-invasive prognostic value. Objectives To assess the prognostic utility of LAVI and TAPSE/PASP compared with invasive haemodynamic parameters in patients with HF and pcPH undergoing RHC. Methods The PH-HF study is a prospective multicentre cohort of adults with chronic HF and confirmed pcPH (mPAP 20 mmHg and PAWP 15 mmHg) enrolled across 13 French centres (2012–2018). Patients with precapillary PH or severe pulmonary/renal comorbidities were excluded. The primary outcome was a 3-year composite of all-cause mortality, urgent heart transplantation or LVAD, or unplanned HF hospitalization. Cox regression was used for survival analyses. Results Overall, 55% of patients met the composite echocardiographic risk criterion (LAVI 35 mL/m2; or TAPSE/PASP 0.40), which was associated with increased risk of adverse events (HR 1.97, 95% CI 1.41–2.75; p 0.0001). Results were consistent across HFrEF and HFpEF phenotypes. In a multivariable model including the MAGGIC score, both the echocardiographic criterion and the clinical score remained independently associated with outcomes, supporting their complementary value in risk stratification. Conclusion LAVI and TAPSE/PASP are strong, non-invasive predictors of adverse outcomes in HF with pcPH and may enhance prognostic assessment beyond invasive haemodynamics and clinical scores.
Berthelot et al. (2026) conducted a cohort in Heart failure with post-capillary pulmonary hypertension. Echocardiographic risk criterion (LAVI > 35 mL/m2 or TAPSE/PASP < 0.40) vs. Patients not meeting the echocardiographic risk criterion was evaluated on 3-year composite of all-cause mortality, urgent heart transplantation or LVAD, or unplanned HF hospitalization (HR 1.97, 95% CI 1.41-2.75, p=<0.0001). An echocardiographic risk criterion (LAVI > 35 mL/m2 or TAPSE/PASP < 0.40) was associated with increased 3-year risk of adverse clinical events in HF with pcPH (HR 1.97; 95% CI 1.41-2.75; p<0.0001).