RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction: Stratification of Clinical Phenotypes and Outcomes

Marco Guazzi, Debra Dixon, Valentina Labate, Lauren Beussink-Nelson, Francesco Bandera, Michael J. Cuttica, Sanijv J. Shah

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objectives This study sought to investigate how right ventricular (RV) contractile function and its coupling with pulmonary circulation (PC) stratify clinical phenotypes and outcome in heart failure preserved ejection fraction (HFpEF) patients. Background Pulmonary hypertension and RV dysfunction are key hemodynamic abnormalities in HFpEF. Methods Three hundred eighty seven HFpEF patients (mean age 64 ± 12 years, 59% females, left ventricular ejection fraction 59 ± 7%) underwent RV and pulmonary hemodynamic evaluation by echocardiography (entire population) and right heart catheterization (219 patients). Patients were investigated by tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) relationship and stratified according to TAPSE/PASP ratio tertiles (1: <0.35; 2: 0.35 to 0.57; 3: >0.57). Specifically, TAPSE/PASP ratio was taken as a noninvasive index of RV to PC coupling based on the correlation with invasively evaluated RV systolic elastance/arterial elastance (r = 0.35; p < 0.0001). Results Groups had similar prevalence of comorbidities except for a higher prevalence of atrial fibrillation and kidney dysfunction in tertile 1. Progressively increasing levels of natriuretic peptides, worse systemic and pulmonary hemodynamics, abnormal exercise aerobic capacity and ventilatory inefficiency were observed from the highest to lowest TAPSE/PASP tertile. TASPE/PASP correlated with pulmonary artery compliance (r = 0.69; p < 0.0001). Remarkably, the tertile 1 group distributed along the worse portion of the curve at lower pulmonary artery compliance and higher pulmonary vascular resistances. In addition, the TAPSE/PASP ratio emerged as an independent predictor of worse outcomes. Conclusions A thorough assessment of RV-PC coupling and RV contractile function stratify HFpEF phenotypes at different level of risk. These observations shift the interest toward therapeutic strategies that may benefit the right heart as primary unmet need in the complex pathophysiology of the HFpEF syndrome.

Original languageEnglish
Pages (from-to)1211-1221
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume10
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Right Ventricular Function
Pulmonary Circulation
Pulmonary Artery
Heart Failure
Phenotype
Blood Pressure
Lung Compliance
Hemodynamics
Right Ventricular Dysfunction
Lung
Natriuretic Peptides
Cardiac Catheterization
Pulmonary Hypertension
Vascular Resistance
Stroke Volume
Atrial Fibrillation
Echocardiography
Comorbidity
Exercise
Kidney

Keywords

  • heart failure with preserved ejection fraction
  • hemodynamics
  • pulmonary hypertension
  • right ventricle

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction : Stratification of Clinical Phenotypes and Outcomes. / Guazzi, Marco; Dixon, Debra; Labate, Valentina; Beussink-Nelson, Lauren; Bandera, Francesco; Cuttica, Michael J.; Shah, Sanijv J.

In: JACC: Cardiovascular Imaging, Vol. 10, No. 10, 01.10.2017, p. 1211-1221.

Research output: Contribution to journalArticle

@article{72f5ab0c387b474182faf7c14e369ffa,
title = "RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction: Stratification of Clinical Phenotypes and Outcomes",
abstract = "Objectives This study sought to investigate how right ventricular (RV) contractile function and its coupling with pulmonary circulation (PC) stratify clinical phenotypes and outcome in heart failure preserved ejection fraction (HFpEF) patients. Background Pulmonary hypertension and RV dysfunction are key hemodynamic abnormalities in HFpEF. Methods Three hundred eighty seven HFpEF patients (mean age 64 ± 12 years, 59{\%} females, left ventricular ejection fraction 59 ± 7{\%}) underwent RV and pulmonary hemodynamic evaluation by echocardiography (entire population) and right heart catheterization (219 patients). Patients were investigated by tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) relationship and stratified according to TAPSE/PASP ratio tertiles (1: <0.35; 2: 0.35 to 0.57; 3: >0.57). Specifically, TAPSE/PASP ratio was taken as a noninvasive index of RV to PC coupling based on the correlation with invasively evaluated RV systolic elastance/arterial elastance (r = 0.35; p < 0.0001). Results Groups had similar prevalence of comorbidities except for a higher prevalence of atrial fibrillation and kidney dysfunction in tertile 1. Progressively increasing levels of natriuretic peptides, worse systemic and pulmonary hemodynamics, abnormal exercise aerobic capacity and ventilatory inefficiency were observed from the highest to lowest TAPSE/PASP tertile. TASPE/PASP correlated with pulmonary artery compliance (r = 0.69; p < 0.0001). Remarkably, the tertile 1 group distributed along the worse portion of the curve at lower pulmonary artery compliance and higher pulmonary vascular resistances. In addition, the TAPSE/PASP ratio emerged as an independent predictor of worse outcomes. Conclusions A thorough assessment of RV-PC coupling and RV contractile function stratify HFpEF phenotypes at different level of risk. These observations shift the interest toward therapeutic strategies that may benefit the right heart as primary unmet need in the complex pathophysiology of the HFpEF syndrome.",
keywords = "heart failure with preserved ejection fraction, hemodynamics, pulmonary hypertension, right ventricle",
author = "Marco Guazzi and Debra Dixon and Valentina Labate and Lauren Beussink-Nelson and Francesco Bandera and Cuttica, {Michael J.} and Shah, {Sanijv J.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1016/j.jcmg.2016.12.024",
language = "English",
volume = "10",
pages = "1211--1221",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "NLM (Medline)",
number = "10",

}

TY - JOUR

T1 - RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction

T2 - Stratification of Clinical Phenotypes and Outcomes

AU - Guazzi, Marco

AU - Dixon, Debra

AU - Labate, Valentina

AU - Beussink-Nelson, Lauren

AU - Bandera, Francesco

AU - Cuttica, Michael J.

AU - Shah, Sanijv J.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objectives This study sought to investigate how right ventricular (RV) contractile function and its coupling with pulmonary circulation (PC) stratify clinical phenotypes and outcome in heart failure preserved ejection fraction (HFpEF) patients. Background Pulmonary hypertension and RV dysfunction are key hemodynamic abnormalities in HFpEF. Methods Three hundred eighty seven HFpEF patients (mean age 64 ± 12 years, 59% females, left ventricular ejection fraction 59 ± 7%) underwent RV and pulmonary hemodynamic evaluation by echocardiography (entire population) and right heart catheterization (219 patients). Patients were investigated by tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) relationship and stratified according to TAPSE/PASP ratio tertiles (1: <0.35; 2: 0.35 to 0.57; 3: >0.57). Specifically, TAPSE/PASP ratio was taken as a noninvasive index of RV to PC coupling based on the correlation with invasively evaluated RV systolic elastance/arterial elastance (r = 0.35; p < 0.0001). Results Groups had similar prevalence of comorbidities except for a higher prevalence of atrial fibrillation and kidney dysfunction in tertile 1. Progressively increasing levels of natriuretic peptides, worse systemic and pulmonary hemodynamics, abnormal exercise aerobic capacity and ventilatory inefficiency were observed from the highest to lowest TAPSE/PASP tertile. TASPE/PASP correlated with pulmonary artery compliance (r = 0.69; p < 0.0001). Remarkably, the tertile 1 group distributed along the worse portion of the curve at lower pulmonary artery compliance and higher pulmonary vascular resistances. In addition, the TAPSE/PASP ratio emerged as an independent predictor of worse outcomes. Conclusions A thorough assessment of RV-PC coupling and RV contractile function stratify HFpEF phenotypes at different level of risk. These observations shift the interest toward therapeutic strategies that may benefit the right heart as primary unmet need in the complex pathophysiology of the HFpEF syndrome.

AB - Objectives This study sought to investigate how right ventricular (RV) contractile function and its coupling with pulmonary circulation (PC) stratify clinical phenotypes and outcome in heart failure preserved ejection fraction (HFpEF) patients. Background Pulmonary hypertension and RV dysfunction are key hemodynamic abnormalities in HFpEF. Methods Three hundred eighty seven HFpEF patients (mean age 64 ± 12 years, 59% females, left ventricular ejection fraction 59 ± 7%) underwent RV and pulmonary hemodynamic evaluation by echocardiography (entire population) and right heart catheterization (219 patients). Patients were investigated by tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) relationship and stratified according to TAPSE/PASP ratio tertiles (1: <0.35; 2: 0.35 to 0.57; 3: >0.57). Specifically, TAPSE/PASP ratio was taken as a noninvasive index of RV to PC coupling based on the correlation with invasively evaluated RV systolic elastance/arterial elastance (r = 0.35; p < 0.0001). Results Groups had similar prevalence of comorbidities except for a higher prevalence of atrial fibrillation and kidney dysfunction in tertile 1. Progressively increasing levels of natriuretic peptides, worse systemic and pulmonary hemodynamics, abnormal exercise aerobic capacity and ventilatory inefficiency were observed from the highest to lowest TAPSE/PASP tertile. TASPE/PASP correlated with pulmonary artery compliance (r = 0.69; p < 0.0001). Remarkably, the tertile 1 group distributed along the worse portion of the curve at lower pulmonary artery compliance and higher pulmonary vascular resistances. In addition, the TAPSE/PASP ratio emerged as an independent predictor of worse outcomes. Conclusions A thorough assessment of RV-PC coupling and RV contractile function stratify HFpEF phenotypes at different level of risk. These observations shift the interest toward therapeutic strategies that may benefit the right heart as primary unmet need in the complex pathophysiology of the HFpEF syndrome.

KW - heart failure with preserved ejection fraction

KW - hemodynamics

KW - pulmonary hypertension

KW - right ventricle

UR - http://www.scopus.com/inward/record.url?scp=85017435419&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017435419&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2016.12.024

DO - 10.1016/j.jcmg.2016.12.024

M3 - Article

AN - SCOPUS:85017435419

VL - 10

SP - 1211

EP - 1221

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 10

ER -