Key result
Right ventricular dysfunction assessed by TAPSE (<17mm) was associated with increased 30-month all-cause mortality in HFmrEF patients (aHR 1.482; 95% CI 1.126-1.951; p=0.005).
Why the study?
Data investigating the prevalence and prognostic impact of cardio-hepatic syndrome and right ventricular dysfunction in patients with HFmrEF are scarce.
Does the presence of cardio-hepatic syndrome or right ventricular dysfunction predict all-cause mortality and HF-related rehospitalization in patients with HFmrEF?
Cohort (n=794)
No
Does the presence of cardio-hepatic syndrome or right ventricular dysfunction predict all-cause mortality and HF-related rehospitalization in patients with HFmrEF?
In patients with HFmrEF, right ventricular dysfunction assessed by TAPSE or TAPSE/PASP is independently associated with increased all-cause mortality, carrying greater prognostic significance than cardio-hepatic syndrome.
OBJECTIVE: Right ventricular dysfunction (RVD) is common in patients with heart failure (HF) and reduced ejection fraction and may lead to cardio-hepatic syndrome (CHS). The present study investigates the prevalence and prognostic impact of CHS and RVD in heart failure with mildly reduced ejection fraction (HFmrEF). BACKGROUND: Data investigating the prognostic impact of CHS and RVD in patients with HFmrEF are scarce. METHODS: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of CHS (≥2 increased cholestasis parameters), as well as RVD assessed by tricuspid plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and right ventricular fractional area change (RV FAC) was investigated regarding the risk of all-cause mortality and HF-related rehospitalization at 30 months. RESULTS: 794 HFmrEF patients were included of whom 20.3% suffered from CHS and up to 20.9% from RVD. At 30 months, the CHS was not associated the risk of 30-months all-cause mortality (adjusted hazard ratio (aHR)=1.316; 95% confidence interval (CI) 0.990-1.751; p=0.059). In contrast, RVD assessed by the TAPSE (< 17mm; aHR=1.482; 95% CI 1.126-1.951; p=0.005) and the TAPSE/PASP (<0.36mm/mmHg; aHR=1.566; 95% CI 1.092-2.245; p=0.015) predicted the risk of the primary endpoint. Finally, neither the CHS, nor RVD were associated with the risk of HF-related rehospitalization. CONCLUSION: CHS and RVD are prevalent in 20% of patients with HFmrEF, whereas the TAPSE or TASPE/PASP were independently associated with increased all-cause mortality. In HFmrEF patients, RVD may carry greater prognostic significance as compared to the CHS.
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Schupp et al. (2026) conducted a cohort in Heart failure with mildly reduced ejection fraction (HFmrEF) (n=794). Right ventricular dysfunction (RVD) vs. Absence of RVD was evaluated on 30-months all-cause mortality (aHR 1.482, 95% CI 1.126-1.951, p=0.005). Right ventricular dysfunction assessed by TAPSE (<17mm) was associated with increased 30-month all-cause mortality in HFmrEF patients (aHR 1.482; 95% CI 1.126-1.951; p=0.005).
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