Longitudinal 2-dimensional strain of RV free wall/PASP ratio independently predicted 180-day death or HF hospitalization (HR 0.30; 95% CI 0.13-0.67; P=0.004) with superior discrimination to TAPSE/PASP.
Observational (n=425)
Yes
Does longitudinal 2-dimensional strain of RV free wall/PASP ratio better predict outcomes compared to TAPSE/PASP ratio in patients with acute heart failure?
In acute heart failure, the ratio of RV free wall longitudinal strain to PASP is a superior prognostic discriminator compared to TAPSE/PASP, particularly in patients with preserved ejection fraction.
Effect estimate: HR 0.30 (95% CI 0.13-0.67)
p-value: p=0.004
Background Assessment of right ventricular–pulmonary artery coupling plays a crucial role in risk stratification, monitoring efficacy, and predicting outcomes in chronic heart failure patients. However, data in acute heart failure (AHF) are still lacking. Methods and Results This multicenter observational study includes 425 patients with AHF: 248 with reduced left ventricular ejection fraction (<50%) and 177 with preserved left ventricular ejection fraction (≥50%). Pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), longitudinal 2‐dimensional strain of right ventricular (RV) free wall, and the RV end‐diastolic diameter were measured by echocardiography. TAPSE/PASP and longitudinal 2‐dimensional strain of RV free wall/PASP ratios were calculated as noninvasive surrogates of right ventricular–pulmonary artery coupling. The end point was a composite of all‐cause death/HF‐related hospitalizations assessed at 180 days. At 180 days, 197 patients (46.4%) reached the end point. After multivariable adjustment for RV end‐diastolic diameter, E/e′ ratio, left ventricular ejection fraction, and natriuretic peptides, although both TAPSE/PASP (hazard ratio HR, 0.49 95% CI, 0.25–0.27; P =0.042) and longitudinal 2‐dimensional strain of RV free wall/PASP (HR, 0.30 95% CI, 0.13–0.67; P =0.004) had a statistically significant association with the end point, and longitudinal 2‐dimensional strain of RV free wall/PASP better discriminated between patients with and without events compared with TAPSE/PASP (area under the curve, 0.70 versus 0.66; P =0.0041). Interestingly, the superiority of longitudinal 2‐dimensional strain of RV free wall/PASP over the TAPSE/PASP ratio was more evident in patients with AHF with preserved ejection fraction (area under the curve, 0.72 versus 0.64; P <0.001) than in those with AHF with reduced ejection fraction (AUC, 0.67 versus 0.64; P =NS). Conclusions In patients with AHF, both TAPSE/PASP and longitudinal 2‐dimensional strain of RV free wall/PASP are independent predictor of prognosis. However, longitudinal 2‐dimensional strain of RV free wall/PASP showed a superior discriminator capability in identifying patients with events, mainly in the AHF with preserved ejection fraction subgroup. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02638142.
Palazzuoli et al. (2025) conducted an observational in Acute heart failure (n=425). Longitudinal 2-dimensional strain of RV free wall/PASP ratio vs. TAPSE/PASP ratio was evaluated on Composite of all-cause death/HF-related hospitalizations (HR 0.30, 95% CI 0.13-0.67, p=0.004). Longitudinal 2-dimensional strain of RV free wall/PASP ratio independently predicted 180-day death or HF hospitalization (HR 0.30; 95% CI 0.13-0.67; P=0.004) with superior discrimination to TAPSE/PASP.