Higher right ventricular end-ejection pressure (RVEEP) was strongly associated with mortality in patients with PH-HFpEF (HR 1.82; 95% CI 1.11-2.99; p=0.018).
Cohort (n=80)
Does higher right ventricular end-ejection pressure (RVEEP) predict mortality in patients with pulmonary hypertension associated with heart failure with preserved ejection fraction (PH-HFpEF)?
In patients with PH-HFpEF, higher right ventricular end-ejection pressure (RVEEP) is a strong, physiologically grounded hemodynamic predictor of mortality that outperforms traditional indices like PVR and PAC.
Effect estimate: HR 1.82 (95% CI 1.11-2.99)
p-value: p=0.018
Abstract Rationale Pulmonary hypertension (PH) complicates heart failure with preserved ejection fraction (HFpEF) as transmitted elevated left atrial pressure promotes pulmonary vascular remodeling and increases right ventricular (RV) afterload. Hemodynamic predictors of mortality in PH-HFpEF remain poorly defined. The RV pressure at end-ejection (RVEEP), measured immediately before pulmonic valve closure, reflects the residual pulsatile load on the RV and efficiency of pressure decay. We hypothesized that higher RVEEP would predict PH-HFpEF mortality. Methods PH-HFpEF patients undergoing right-heart catheterization between 2019-2024 were included. RV pressure waveforms were analyzed to derive RVEEP and other advanced hemodynamics using a validated pressure-derivative approach (Oakland, et al. PMID: 34043473). RVEEP was defined as the instantaneous RV pressure preceding pulmonic valve closure. LASSO penalized logistic regressions were applied, identifying hemodynamic predictors of mortality. Variables consistently selected were entered into a logistic regression for all-cause mortality association measurement. A cross-validated penalized Cox model identified predictors of time to death. Variables retained in ≥ 90% of repetitions were refit in a Cox model. Patients were stratified by median predicted risk for Kaplan-Meier analyses. Results Among 80 patients with PH-HFpEF (64 Cpc-PH, 16 Ipc-PH; 65% female), mean age was 67 ± 14 years. Compared with Ipc-PH, Cpc-PH patients had higher NT-proBNP, right atrial pressure, mean pulmonary artery pressure, pulmonary vascular resistance (PVR), and RA/PAWP; and lower cardiac output and pulmonary arterial compliance (PAC). Advanced measures showed higher arterial elastance, characteristic impedance, and RVEEP. In cross-validated models, RVEEP was the most consistent and discriminative predictor of mortality, outperforming hemodynamic indices including PVR and PAC. Using the entire dataset, higher RVEEP was strongly associated with death (β = 1.39, p = 0.0003, AUC=0.81); this relationship persisted in survival analyses (HR 1.82, 95% CI 1.11-2.99, p = 0.018). RA/PAWP (HR 1.73, p = 0.052) and NT-proBNP (HR 1.29, p = 0.08) added complementary prognostic information. A composite score combining all three variables stratified risk: nearly all Cpc-PH were high-risk (39/40, 98%), whereas most Ipc-PH were low-risk (15/16, 94%) (Figure 1). Conclusions In PH-HFpEF, higher RVEEP was consistently the strongest hemodynamic predictor of mortality. This pressure reflects the residual load borne by the RV immediately before pulmonic valve closure. RA/PAWP and NT-proBNP added complementary insight, reflecting effects of right-sided congestion and myocardial stress. Together, these findings identify RVEEP as a physiologically grounded, dynamic marker that refines risk stratification and illuminates mechanisms of RV-pulmonary vascular dysfunction in PH-HFpEF. This abstract is funded by: None
Tarras et al. (2026) conducted a cohort in Pulmonary hypertension associated with heart failure with preserved ejection fraction (PH-HFpEF) (n=80). Right ventricular end-ejection pressure (RVEEP) was evaluated on Mortality (HR 1.82, 95% CI 1.11-2.99, p=0.018). Higher right ventricular end-ejection pressure (RVEEP) was strongly associated with mortality in patients with PH-HFpEF (HR 1.82; 95% CI 1.11-2.99; p=0.018).