Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure With Preserved Ejection Fraction.
J Clin Med
; 9(3)2020 Mar 18.
Article
in En
| MEDLINE
| ID: mdl-32197527
ABSTRACT
Right ventricular dysfunction (RVD) parameters are increasingly important features in heart failure with preserved ejection fraction (HFpEF). We sought to evaluate the prognostic impact of a progressive RVD staging system by combining the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (TAPSE/PASP) ratio with functional tricuspid regurgitation (TR) severity. We prospectively included 1355 consecutive HFpEF patients discharged for acute heart failure (HF). Of them, in 471 (34.7%) patients, PASP could not be accurately measured, leaving the final sample size to be 884 patients. Patients were categorized as Stage 1 TAPSE/PASP ≥ 0.36 without significant TR; stage 2 TAPSE/PASP ≥ 0.36 with significant TR; stage 3 TAPSE/PASP < 0.36 without significant TR; and stage 4 TAPSE/PASP < 0.36 with significant TR. By the 1 year follow-up, 207 (23.4%) patients had died. We found a significant and graded association between RVD stages and mortality rates (15.8%, 25%, 31.2%, and 45.4% from stage 1 to stage 4, respectively; log-rank test, p < 0.001). After multivariable adjustment, and compared to stage 1, stages 3 and 4 were independently associated with mortality risk (HR 1.8219; 95% CI 1.308-2.538; p < 0.001 and HR = 2.2632; 95% CI 1.540-3.325; p < 0.001, respectively). A RVD staging system, integrating TAPSE/PASP and TR, provides a comprehensive and widely available tool for risk stratification in HFpEF.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Language:
En
Journal:
J Clin Med
Year:
2020
Document type:
Article
Affiliation country:
Spain