Right Heart Dysfunction and Readmission Risk Across Left Ventricular Ejection Fraction Status in Patients With Acute Heart Failure

• Published in: Journal of cardiac failure Vol. 27; no. 10; pp. 1090 - 1098
• Main Authors: Santas, Enrique, Miñana, Gema, Palau, Patricia, Espriella, Rafael De La, Lorenzo, Miguel, Núñez, Gonzalo, Sanchis, Juan, Chorro, Francisco Javier, Bayes-Genís, Antoni, Núñez, Julio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2021
• Subjects: Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Humans; left ventricular ejection fraction; Patient Readmission; Prognosis; readmissions; right heart dysfunction; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right; Heart failure; readmissions; right heart dysfunction; left ventricular ejection fraction
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2021.06.020

•Right heart dysfunction parameters are increasingly important in heart failure.•The combination of a reduced tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio and a significant tricuspid regurgitation is associated with a higher risk of recurrent cardiovascular and heart failure admissions.•This association in mainly observed in patients with left ventricular ejection fraction of 40% or greater, because no significant differences were observed in patients with heart failure with reduced ejection fraction.
Right heart dysfunction (RHD) parameters are increasingly important in heart failure (HF). This study aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF).
We included 3383 consecutive patients discharged for acute HF. Of them, in 1435 patients (42.4%), the pulmonary artery systolic pressure could not be measured accurately, leaving a final sample size of 1948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure of less than 0.36 and significant tricuspid regurgitation (n = 196, 10.2%). Negative binomial regression analyses were used to evaluate the risk of recurrent admissions. At a median follow-up of 2.2 years (interquartile range 0.63–4.71), 3782 readmissions were registered in 1296 patients (66.5%). Patients with advanced RHD showed higher readmission rates, but only if the LVEF was 40% or greater (P < .001). In multivariable analyses, this differential association persisted for cardiovascular and HF recurrent admissions (P value for interaction = .015 and P = .016; respectively). Advanced RHD was independently associated with the risk of recurrent cardiovascular and HF admissions if HF with an LVEF of 40% or greater (incidence rate ratio 1.64, 95% confidence interval 1.18–2.26, P = .003; and incidence rate ratio 1.73; 95% confidence interval 1.25–2.41, P = .001;respectively). In contrast, it was not associated with readmission risks if the LVEF was less than 40%.
After an admission for acute HF, advanced RHD was strongly associated with a higher risk of recurrent cardiovascular and HF admissions, but only in patients with an LVEF of 40% or greater.
[Display omitted] (A) Study flow chart. (B) Rates of CV and HF recurrent admissions per 100 person-years in patients with HF with LVEF of less than 40% or 40% or greater, according to advanced RHD parameters. (C) Risk of recurrent CV and HF-related admissions in the multivariable regression models associated with advanced RHD (TAPSE/PASP of <0.36 with significant TR). CI, confidence interval; CV, cardiovascular; HF, heart failure; LVEF, left ventricular ejection fraction; PASP, pulmonary arterial systolic pressure; RHD, right heart dysfunction; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation.