Right ventricular (RV) dysfunction and impaired RV-pulmonary artery coupling (RV-PA) in patients with acutely decompensated heart failure (HF) were found to be associated with greater severity and lower resolution of pulmonary congestion, according to a study published in Clinical Research in Cardiology.

This was a meta-analysis of 4 cohort studies in which patients hospitalized for HF with available lung ultrasound data were enrolled. Tricuspid annular plane systolic excursion (TAPSE) was used to evaluate RV function, and the TAPSE to pulmonary artery systolic pressure (PASP) ratio was used to measure RV-PA coupling. In total, the admission cohort included 319 patients (mean age, 75.8±10.1; 45.5% women; LV ejection fraction [LVEF], 39.2±13.9%) and the discharge cohort had 221 patients (mean age, 77.9±9.0 years; 46.6% women; LVEF, 41.5±13.3%). The study’s primary outcome was a composite of all-cause death or rehospitalization for HF.

Within each cohort, patients were separated according to the TAPSE tertiles: in the admission group:  low, TAPSE <16 mm; intermediate, TAPSE between 16 and 20 mm; and high, TAPSE >20 mm. Patients with higher TAPSE were less likely to have ischemic heart disease (P =.008) and had higher systolic blood pressure (P =.004). In the discharge group, low TAPSE was defined as TAPSE <17 mm, intermediate TAPSE was between 17 and 20 mm, and high TAPSE >20 mm. Patients with higher TAPSE in the discharge group had less severe congestion (P ≤.008). In both cohorts, patients with higher TAPSE had higher ejection fractions (P ≤.008), lower PA systolic pressure (PASP; P <.001), smaller inferior vena cava diameters (P <.001), lower B-type natriuretic peptide levels (P ≤.001), and lower B-line counts (P ≤.008).


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After correcting for all covariates, a lower TAPSE to PASP ratio was significantly associated with higher B-line counts at hospital admission and discharge (P <.05 for both). During hospital stay, patients with an initially high TAPSE and TAPSE to PASP ratio had greater reductions in B-line counts (P <.05).

The primary outcome occurred in 34.2% of patients in the admission cohort in 35.7% of those in the discharge cohort, and was more likely to occur among patients with greater B-line counts at discharge (adjusted hazard ratio [HR], 1.13; 95% CI, 1.09-1.16; P <.001), but not at admission. At 90 days, the risk for the primary outcome related to B-line counts was higher among the low (53.1%) and intermediate (53.5%) TAPSE groups compared with the high TAPSE group (18.7%).

Study limitations include its meta-analysis design. In addition, B-line counts were variable across the 4 studies examined.

“These data support the clinical importance of right-sided cardiac function which may be a relevant factor favoring the development and persistence of pulmonary congestion, and influencing worse prognosis of residual pulmonary congestion,” noted the study authors. “Our results also emphasize the key importance of assessing pulmonary residual congestion in patients with acutely decompensated HF.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Kobayashi M, Gargani L, Palazzuoli A, et al. Association between right‑sided cardiac function and ultrasound‑based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies. [published online August 9, 2020] Clin Res Cardiol. doi:10.1007/s00392-020-01724-8