TAPSE/sPAP <0.65 mm/mmHg at follow-up during GDMT up-titration was strongly associated with an increased risk of all-cause death or acute HF hospitalization (HR 5.9; 95% CI 2.8-12.1; p<0.001).
Cohort (n=291)
No
Does GDMT up-titration improve RV-PA coupling, and is TAPSE/sPAP associated with reduced all-cause death or HF hospitalization in patients with LVEF <50%?
GDMT up-titration improves RV-PA coupling, and a low TAPSE/sPAP at follow-up is a strong independent predictor of mortality or HF hospitalization in patients with HFrEF.
Hazard Ratio: 5.9 (95% CI 2.8–12.1)
p-value: p=<0.001
Abstract Background and Aims Up-titration of guidelines-directed medical therapy (GDMT) is known to enhance left ventricular function in heart failure (HF) with reduced ejection fraction. However, its effect on right ventricular (RV) function remains sparse. We aimed to assess the impact of GDMT up-titration on the RV, especially RV to pulmonary artery (RV-PA) coupling, and its prognostic value in these patients. Methods and Results All consecutive patients (n=291) with left ventricular ejection fraction (LVEF) 50% followed for GDMT up-titration in a dedicated HF-clinic in a tertiary center from January 2019 to June 2022 with an echocardiography at baseline (before up-titration) and at follow up (end of up-titration) were included: median age 65 (55-74) years, 24% of female. Ischemic cardiomyopathy was the main cause of HF (47%), LVEF 30% (22-34). After 2 years, fourty-nine patients (16.8%) reached the primary endpoint (all-cause death or hospitalization for acute HF). GDMT up-titration significantly improved RV size and function (all, p0.001), including RV-PA coupling assessed by TAPSE/sPAP (0.62 vs. 0.81 mm/mmHg, p0.001). TAPSE/sPAP 0.65 mm/mmHg at follow-up remained associated with the primary endpoint after adjustment with comorbidities (HR=5.9, 95%CI2.8–12.1, p0.001), clinical and biological severity (HR=6.4, 95%CI2.4–17.8, p0.001), and echocardiography (HR=3.6, 95%CI1.6–8.4, p=0.002). In addition, TAPSE/sPAP was associated with an incremental prognostic value (C-index improvement, p0.01, Figure D), over and above prognostic factors, including LVEF (Figure). Patients with low TAPSE/sPAP, at baseline (Figure A), at follow-up (Figure B) or patients with the lowest delta (i.e., follow-up minus baseline) improvement had lower survival (log-rank p0.01). Conclusion This study highlights the independent and incremental prognostic value of TAPSE/sPAP in HFrEF during GDMT up-titration, suggesting to also consider RV-PA coupling with echocardiography as a treatment goal.
Fauvel et al. (Sat,) conducted a cohort in Heart failure with reduced ejection fraction (n=291). TAPSE/sPAP <0.65 mm/mmHg at follow-up was evaluated on all-cause death or hospitalization for acute HF (HR 5.9, 95% CI 2.8-12.1, p=<0.001). TAPSE/sPAP <0.65 mm/mmHg at follow-up during GDMT up-titration was strongly associated with an increased risk of all-cause death or acute HF hospitalization (HR 5.9; 95% CI 2.8-12.1; p<0.001).