Ventriculo-arterial coupling in acute heart failure: prognostic and therapeutic insights - a systematic review and meta-analysis of multivariable-adjusted data

Figures

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  Fig. 1. (A) Graphical abstract: Population and main findings. 36,989 patients admitted with de-novo or acutely decompensated AHF, characterized by ventricular-arterial coupling: bedside non-invasive hemodynamic parameter representative of the right ventricle, respectively left ventricle and afterload interplay. (B) PRISMA flow diagram of study screening and selection Abbreviations: ACE = adverse cardiovascular events; ACM = all-cause mortality; AHF = acute heart failure; aHR = adjusted hazard ratio; aOR = adjusted odds ratio; BP = blood pressure; CI = confidence interval; ePASP = estimated pulmonary artery systolic pressure (estimated right atrial pressure plus right ventricle–right atrium pressure gradient); HF = heart failure; LV-Ao = left ventricle–systemic circulation; LVEF Simpson BP = left ventricular ejection fraction measured by the Simpson biplane method; RV-PA = right ventricle–pulmonary circulation; STIs = systolic time intervals; SV–VTI = stroke volume calculated using left ventricular outflow tract diameter and velocity–time integral; TAPSE = tricuspid annular plane systolic excursion; VAC = ventriculo–arterial coupling; WoS = Web of Science

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  Fig. 2. Ventriculo-arterial uncoupling and adverse clinical outcomes in AHF: (A) RV-PA uncoupling is associated with increased risk of all-cause mortality; (B) LV-Ao uncoupling is significantly associated with higher odds of in-hospital adverse cardiovascular events. Abbreviations: AHF = acute heart failure; LV-Ao = left ventricle–systemic circulation; RV-PA = right ventricle–pulmonary circulation. Jentzer 2021* effect estimate source: Figure 3B (Hazard ratios for TASV/RVSP quintiles were extracted from Figure 3B using WebPlotDigitizer (Automeris v5.2)). Comparator: Q1 vs Q5. In Jentzer et al., coupling was defined as tricuspid annular systolic velocity (TASV, S′) divided by estimated pulmonary artery systolic pressure, with TAPSE/PASP calculated when available. TASV and TAPSE were considered equivalent measures of right ventricular longitudinal systolic function. In the leave-one-out sensitivity analysis the results were not dependent on the Jentzer 2021 study.

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  Fig. 3. RV-PA uncoupling was associated with a trend toward: A. Increased heart failure hospitalization; B. Longer hospital stay; C. Increased composite risk of all-cause mortality and heart failure hospitalization Abbreviations: RV-PA = right ventricle–pulmonary circulation

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  Fig. 4. (A) Subgroup analyses stratified by follow-up duration: RV-PA uncoupling remained associated with an increased risk of all-cause mortality; (B) Subgroup analyses for all-cause mortality across the LVEF spectrum: RV-PA uncoupling was significantly associated with increased all-cause mortality in AHFpEF-only; in contrast, among AHF cohorts spanning the LVEF spectrum, RV-PA uncoupling was associated with a non-significant trend toward higher all-cause mortality. Abbreviations: AHFpEF = acute heart failure with preserved ejection fraction; LVEF = left ventricular ejection fraction; RV-PA = right ventricle–pulmonary circulation. Jentzer 2021* effect estimate source: Figure 3B (Hazard ratios for TASV/RVSP quintiles were extracted from Figure 3B using WebPlotDigitizer (Automeris v5.2)). Comparator: Q1 vs Q5. In Jentzer et al., coupling was defined as tricuspid annular systolic velocity (TASV, S′) divided by estimated pulmonary artery systolic pressure, with TAPSE/PASP calculated when available. TASV and TAPSE were considered equivalent measures of right ventricular longitudinal systolic function. In the leave-one-out sensitivity analysis the results were not dependent on the Jentzer…