Key result
Low pulmonary artery compliance (<4.9 mL/mm Hg) was an independent predictor of all-cause death and heart failure hospitalization in patients with right ventricular dysfunction (HR 2.51).
Why the study?
Evidence regarding optimal haemodynamic parameters and prognostic predictors in right ventricular dysfunction remains limited.
Cohort (n=155)
No
Hazard Ratio: 2.51 (95% CI 1.1–5.73)
Absolute Event Rate: 29.9% vs 14.1%
p-value: p=0.029
In patients with right ventricular dysfunction, optimizing right atrial pressure to 10-15 mm Hg maximizes cardiac output, while reduced pulmonary artery compliance serves as an independent predictor of adverse clinical outcomes.
May refine prognostication in right ventricular dysfunction; leaves open prospective validation before guiding therapy.
BACKGROUND: Evidence regarding optimal haemodynamic parameters and prognostic predictors in right ventricular dysfunction (RVD) remains limited. The aim of this study was to examine the relationship between haemodynamic parameters and cardiac output (CO) in RVD and to identify clinically relevant prognostic predictors. METHODS: This retrospective, single-centre cohort study analysed data from patients with heart failure complicated by RVD between 2014 and 2024. RVD was defined as Pulmonary Artery Pulsatility Index <1.85 and right atrial pressure (RAP)/pulmonary artery wedge pressure ratio >0.63. Two substudies were conducted: Study A assessed the relationship between CO and haemodynamic parameters derived from right heart catheterisation (RHC) and Study B evaluated the prognostic value of haemodynamic indices in RVD. The primary outcome of Study B was a composite of all-cause death and heart failure hospitalisation. RESULTS: A total of 202 RHC examinations from 155 patients (median age 69 years, 66% male) were analysed. In Study A, cardiac output was highest at an RAP of approximately 10-15 mm Hg and declined beyond this level. CO showed a non-linear association with heart rate in sinus rhythm, reaching its peak at around 80 beats per minute. In Study B, 34 patients experienced the primary outcome during a median follow-up of 1.4 years. Those who experienced the primary outcome had higher RAP and lower pulmonary artery (PA) compliance. In Kaplan-Meier analysis, RAP >10 mm Hg (median) and PA compliance <4.9 mL/mm Hg (median) were associated with the primary outcome (p=0.004 and p=0.005, respectively). On multivariable Cox regression analysis, PA compliance <4.9 mL/mm Hg was a predictor of the primary outcome, while RAP >10 mm Hg was not. CONCLUSIONS: In patients with RVD, CO was highest at an RAP of 10-15 mm Hg. Among those with sinus rhythm, heart rate showed a non-linear association with CO. Low PA compliance was a predictor of adverse events.
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Suzuki et al. (2026) conducted a cohort in Right ventricular dysfunction in heart failure (n=155). Low pulmonary artery (PA) compliance (<4.9 mL/mm Hg) vs. High pulmonary artery compliance (≥4.9 mL/mm Hg) was evaluated on Composite of all-cause death and hospitalisation for heart failure (HR 2.51, 95% CI 1.10-5.73, p=0.029). Low pulmonary artery compliance (<4.9 mL/mm Hg) was an independent predictor of all-cause death and heart failure hospitalization in patients with right ventricular dysfunction (HR 2.51).
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