Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode

Roger Hullin; Georgios Tzimas; Nicolas Barras; Tamila Abdurashidova; Nisha Soborun; Stefania Aur; Julien Regamey; Sarah Hugelshofer; Henri Lu; Vanessa Crisinel; Aurelien Daux; Elise Vinet; Sandra Joelle-Regina Mekoa-Mbarga; Matthias Kirsch; Olivier Müller; Olivier Hugli; Pierre Monney

doi:10.1002/ehf2.14077

Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode

ESC Heart Fail. 2022 Dec;9(6):3814-3824. doi: 10.1002/ehf2.14077. Epub 2022 Aug 3.

Authors

Roger Hullin¹, Georgios Tzimas¹, Nicolas Barras¹, Tamila Abdurashidova¹, Nisha Soborun², Stefania Aur¹, Julien Regamey¹, Sarah Hugelshofer¹, Henri Lu¹, Vanessa Crisinel¹, Aurelien Daux¹, Elise Vinet¹, Sandra Joelle-Regina Mekoa-Mbarga¹, Matthias Kirsch², Olivier Müller¹, Olivier Hugli³, Pierre Monney¹

Affiliations

¹ Department of Cardiology, Cardiovascular Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Department of Cardiac Surgery, Cardiovascular Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Emergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

Background: The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients.

Methods and results: This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001).

Conclusions: Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode.

Keywords: Acute heart failure; Decongestion; Left heart systolic and diastolic function; Right heart.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged, 80 and over
Echocardiography
Female
Heart Failure* / complications
Humans
Male
Prognosis
Stroke Volume / physiology
Ventricular Function, Left*