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Open AccessArticle

Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction

1
Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, CIBERCV, avenida Blasco Ibáñez 17, 46010 Valencia, Spain
2
Cardiology Department, Hospital General de Castellón, Universitat Jaume I, avenida de Benicassim 128, 12004 Castellón, Spain
3
Cardiology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, carretera de Canyet s/n, 08196 Badalona, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 831; https://doi.org/10.3390/jcm9030831 (registering DOI)
Received: 22 February 2020 / Revised: 11 March 2020 / Accepted: 16 March 2020 / Published: 18 March 2020
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. View Full-Text
Keywords: heart failure with preserved ejection fraction; right ventricular; risk stratification heart failure with preserved ejection fraction; right ventricular; risk stratification
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MDPI and ACS Style

Santas, E.; De la Espriella, R.; Chorro, F.J.; Palau, P.; Miñana, G.; Heredia, R.; Amiguet, M.; Merenciano, H.; Sanchis, J.; Lupón, J.; Bayés-Genís, A.; Núñez, J. Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction. J. Clin. Med. 2020, 9, 831.

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