Baseline pulmonary hypertension and/or right ventricular dysfunction, and their persistence at 1 year, were independently associated with increased mortality and heart failure hospitalizations.
Observational (n=1,557)
Are long-term trajectories of SPAP, TAPSE, and TAPSE/SPAP ratio associated with mortality and HF hospitalizations in patients with chronic heart failure?
Long-term worsening of right ventricular function and pulmonary pressures in chronic heart failure patients is associated with increased mortality and hospitalizations.
AIMS: Systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/SPAP ratio trajectories are not fully characterized in chronic heart failure (HF). We assessed very long-term longitudinal SPAP, TAPSE and TAPSE/SPAP trajectories in HF patients, and their dynamic changes in outcomes. METHODS AND RESULTS: Prospective, consecutive, observational registry of real-life HF patients, performing echocardiography studies at baseline and according to a prospectively structured schedule after 1 year, and then every 2 years, up to 15 years. Pulmonary hypertension (PH) was defined as SPAP ≥40 mmHg; right ventricular dysfunction (RVD) was defined at TAPSE ≤16 mm; and TAPSE/SPAP ratio was dichotomized at 0.36 mm/mmHg. The clinical endpoints were all-cause death, the composite endpoint of mortality or HF hospitalization and the number of recurrent HF hospitalizations. The study cohort included 1557 patients. Long-term SPAP trajectory Loess curves were U-shaped with a nadir at 7 years. TAPSE Loess curves showed a marked rise during the first year, with stabilization thereafter. TAPSE/SPAP ratio Loess splines were similar to the later with a smooth decline towards the end. Patients who died had higher SPAP, lower TAPSE and lower TAPSE/SPAP ratio in the preceding period than survivors. Baseline PH and/or RVD were independently associated with mortality and HF-related hospitalizations, and the persistence of one or both entities at 1 year conferred a worse long-term prognosis. CONCLUSIONS: Long-term trajectories for SPAP, TAPSE and TAPSE/SPAP ratio are reported in patients with chronic HF. An increasing SPAP and declining TAPSE and TAPSE/SPAP ratio in the preceding period is associated with higher mortality.
Santiago‐Vacas et al. (Mon,) conducted a observational in Chronic heart failure (n=1,557). Pulmonary hypertension and/or right ventricular dysfunction vs. Absence of pulmonary hypertension or right ventricular dysfunction was evaluated on All-cause death, composite of mortality or HF hospitalization, and number of recurrent HF hospitalizations. Baseline pulmonary hypertension and/or right ventricular dysfunction, and their persistence at 1 year, were independently associated with increased mortality and heart failure hospitalizations.
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