Right ventricular-pulmonary artery coupling in acute heart failure: prognostic significance and implications for intensive care management

Abstract Background/Introduction Heart failure is the inability of the heart to provide sufficient cardiac output to meet the metabolic needs of the body under normal ventricular filling pressures, often requiring hospitalization. It is a major cause of hospital admission in individuals over 65 and is associated with high in-hospital and post-discharge mortality and readmission rates. (1,2) While left ventricular dysfunction, age, and mean systolic pressure are recognized prognostic factors, the role of right ventricular (RV) dysfunction is less clear (3-7). Assessing RV-PA coupling using the echocardiographic TAPSE/PAPS ratio may provide valuable prognostic insight, although it is not yet fully integrated into the management of acute heart failure and intensive cardiac care. Purpose This study aims to evaluate the prognostic role of right ventricular function assessed by the TAPSE/PAPS ratio in patients with acute heart failure. Specifically, it investigates its correlation with in-hospital mortality, six-month follow-up mortality, the need for inotropic support or mechanical circulatory support (MCS) during hospitalization, and readmission due to heart failure exacerbation within six months post-discharge. Methods A prospective study was conducted on 100 consecutive acute heart failure patients admitted to the cardiological intensive care unit. Patients were evaluated at admission, discharge, and six months post-discharge through clinical, laboratory, and echocardiographic assessments. Echocardiographic parameters, including LVEF, RVEDD, SV, S', TAPSE, and TAPSE/PAPS, were analyzed to determine their correlations with mortality and the need for inotropic drugs or MCS. Results The study population included 62 men and 38 women, with an average age of 71 ± 12.5 years. The majority of patients were slightly overweight (BMI 25 ± 3.2), with 56% being smokers and having comorbidities such as hypertension (66%), hyperlipidemia (66%), diabetes (37%), COPD (23%), and chronic kidney disease (21%). In-hospital mortality was significantly correlated with mean arterial pressure (p = 0.03), stroke volume (p = 0.038), S' (p = 0.016), and TAPSE/PAPS (p 0.001), but not with LVEF (p = 0.091). A significant association was also found between the TAPSE/PAPS ratio and mortality in patients requiring inotropes and MCS (p = 0.018 and p = 0.013, respectively). Additionally, a lower TAPSE/PAPS ratio was a significant predictor of post-discharge mortality (p = 0.033). Conclusion(s) The findings suggest that RV-PA coupling, assessed by TAPSE/PAPS at admission, is a significant prognostic factor for in-hospital mortality and need for inotropic support. Furthermore, a reduced TAPSE/PAPS ratio at discharge is associated with increased post-discharge mortality risk. These results indicate that RV-PA coupling could serve as an additional prognostic tool in acute heart failure . Future studies involving larger cohorts are needed to validate these findings.