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Left ventricular systolic function affects right atrial pressure as prognosticator in patients with heart failure

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Abstract

The effect of the left ventricular ejection fraction (LVEF) on the prognostic impact of the right atrial pressure (RAP) in patients with heart failure (HF) requires clarification. We aimed to investigate whether LVEF affects the prognostic impact of RAP estimated from inferior vena cava (IVC) measurements in patients hospitalized with HF. Initially, this observational study included 1349 consecutive patients urgently hospitalized with HF. After patient exclusions, 506 and 484 patients with reduced (< 40%) and with non-reduced (≥ 40%) LVEF, respectively, were assigned according to maximum IVC diameter and its collapsibility, to the Normal-RAP (diameter ≤ 2.1 cm; collapsibility ≥ 50%), High-RAP (diameter > 2.1 cm; collapsibility < 50%), and Intermediate-RAP (others) groups. The endpoint comprised cardiovascular death after discharge and hospitalization for HF recurrence. During the observation period, 247 (49%) patients with LVEF < 40% and 178 (37%) patients with LVEF ≥ 40% experienced the endpoint. The patient subgroups with LVEF < 40% had comparable event rates (ptrend = 0.10). The High-RAP subgroup with LVEF ≥40% had a higher event rate than the other subgroups (p < 0.001). The RAP independently predicted the endpoint in patients with LVEF ≥ 40% (hazard ratio: 1.26; 95% confidence interval: 1.01–1.59). The interaction between the RAP groups and LVEF regarding the primary endpoint was significant (pinteraction = 0.007). Stratifying patients with HF according to IVC measurements may predict the post-discharge cardiovascular prognoses of patients with non-reduced LVEF, but not that of patients with reduced LVEF.

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Abbreviations

eGFR:

Estimated glomerular filtration rate

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

HHF:

Hospitalization as a consequence of heart failure recurrence

IVC:

Inferior vena cava

LVEF:

Left ventricular ejection fraction

PASP:

Pulmonary artery systolic pressure

RAP:

Right atrial pressure

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiography

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Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Chihiro Saito, Kentaro Jujo, Takuro Abe, Motoko Kametani, Kotaro Arai, Yuichiro Minami, Kyomi Ashihara & Nobuhisa Hagiwara

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  1. Chihiro Saito
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  2. Kentaro Jujo
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  3. Takuro Abe
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Correspondence to Kentaro Jujo.

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We reported that stratifying patients with HF according to IVC measurements may predict the worse prognosis of patients with non-reduced LVEF, but not with reduced LVEF.

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Saito, C., Jujo, K., Abe, T. et al. Left ventricular systolic function affects right atrial pressure as prognosticator in patients with heart failure. Int J Cardiovasc Imaging 38, 1671–1682 (2022). https://doi.org/10.1007/s10554-022-02550-x

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  • DOI: https://doi.org/10.1007/s10554-022-02550-x

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