Right ventricle to pulmonary artery coupling in acute heart failure patient and its implication in intensive cardiac care unit

Abstract Heart failure is the inability of the heart to provide sufficient cardiac output to meet the metabolic needs of the body under normal ventricular filling pressures. It is a major cause of hospitalization in individuals over 65 and it is associated with high rates of in-hospital and post-discharge mortality and readmission. The prognostic significance of right ventricular (RV) dysfunction, alongside left ventricular dysfunction, age, and mean systolic pressure, remainsunclear. This study aims at evaluating the prognostic role of right ventricular function assessed by means of the TAPSE/PAPS ratio in acute heart failure patients, investigating its correlation with in-hospitalmortality, six-month follow-up mortality, the need for inotropic support or mechanical circulatory support (MCS) during hospitalization. Methods: This prospective study evaluated 150 consecutive acute heart failure patients admitted to the cardiological intensive care unit. Patients were assessed at admission, discharge, and after six months, including clinical, laboratory, and echocardiographic evaluations. Echocardiographic parameters (LVEF, RVEDD, SV, S', TAPSE, TAPSE/PAPS) were analyzed to investigate correlations with mortality and the use of inotropic drugs or MCS. Results: The study population included 92 men and 58 women, with an average age of 71 ± 12.5 years. Analyzing in-hospital mortality, significant correlations were found with mean arterial pressure (p = 0.03), stroke volume (p =0.038), S' (p = 0.016), and TAPSE/PAPS (p0.001), but not with LVEF (p = 0.091). There was asignificant association between the TAPSE/PAPS ratio and mortality in patients treated with inotropes and MCS (p = 0.018 and p = 0.013, respectively). TAPSE/PAPS was also a significant prognostic marker for post-discharge mortality (p = 0.033). Conclusion: The study suggests that RV-PA coupling, assessed by TAPSE/PAPS at admission, is a significant prognostic factor for in-hospital mortality and is associated with the need for inotropic support during hospitalization. A reduced TAPSE/PAPS ratio at discharge is a negative prognostic indicator for post-discharge mortality. Thus, RV-PA coupling could be used as an additional prognostic tool in ICCU for heart failure patients. These findings should be validated by a larger multicentric cohort and longer follow-up.