Prognostic Impact of Right-Left Filling Pressure Dissociation on Long-Term Outcomes in Heart Failure

Heart failure (HF) is a heterogeneous syndrome in which discordance between right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) can occur. However, the clinical impact of isolated right-sided congestion in stable HF remains unclear. From the A c u te Heart Failure R egistry at O saka R os a i Hospital (AURORA), we analyzed consecutive patients hospitalized for HF between January 2015 and December 2022 who underwent right heart catheterization within 7 days before discharge. Patients were classified by established cut-off values into four groups: Group 1 (RAP < 10 and PCWP < 22), Group 2 (RAP ≥ 10 and PCWP < 22), Group 3 (RAP < 10 and PCWP ≥ 22), and Group 4 (RAP ≥ 10 and PCWP ≥ 22). Clinical endpoints were the composite of HF readmission or all-cause death and HF readmission. Among 334 patients, 265 were in Group 1, 19 in Group 2, 34 in Group 3, and 16 in Group 4. Group 2 was independently associated with an increased risk of the composite of HF readmission or all-cause death and HF readmission compared with Group 1 across the sequentially adjusted multivariable models. In the fully adjusted model, Group 2 was associated with a higher risk of the composite endpoint (hazard ratio, 2.01; 95% confidence interval [CI], 1.03–3.91; P = 0.042) and HF readmission (subdistribution hazard ratio, 3.28; 95% CI, 1.67–6.43; P < 0.001) compared with Group 1. Isolated right-sided congestion was significantly associated with the composite of HF readmission and all-cause death and HF readmission in HF patients.