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

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 pulmona...

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Autores principales: Santas, Enrique, De la Espriella, Rafael, Chorro, Francisco Javier, Palau, Patricia, Miñana, Gema, Heredia, Raquel, Amiguet, Martina, Merenciano, Héctor, Sanchis, Juan, Lupón, Josep, Bayés-Genís, Antoni, Núñez, Julio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141269/
https://www.ncbi.nlm.nih.gov/pubmed/32197527
http://dx.doi.org/10.3390/jcm9030831
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author Santas, Enrique
De la Espriella, Rafael
Chorro, Francisco Javier
Palau, Patricia
Miñana, Gema
Heredia, Raquel
Amiguet, Martina
Merenciano, Héctor
Sanchis, Juan
Lupón, Josep
Bayés-Genís, Antoni
Núñez, Julio
author_facet Santas, Enrique
De la Espriella, Rafael
Chorro, Francisco Javier
Palau, Patricia
Miñana, Gema
Heredia, Raquel
Amiguet, Martina
Merenciano, Héctor
Sanchis, Juan
Lupón, Josep
Bayés-Genís, Antoni
Núñez, Julio
author_sort Santas, Enrique
collection PubMed
description 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.
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spelling pubmed-71412692020-04-10 Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction Santas, Enrique De la Espriella, Rafael Chorro, Francisco Javier Palau, Patricia Miñana, Gema Heredia, Raquel Amiguet, Martina Merenciano, Héctor Sanchis, Juan Lupón, Josep Bayés-Genís, Antoni Núñez, Julio J Clin Med Article 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. MDPI 2020-03-18 /pmc/articles/PMC7141269/ /pubmed/32197527 http://dx.doi.org/10.3390/jcm9030831 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Santas, Enrique
De la Espriella, Rafael
Chorro, Francisco Javier
Palau, Patricia
Miñana, Gema
Heredia, Raquel
Amiguet, Martina
Merenciano, Héctor
Sanchis, Juan
Lupón, Josep
Bayés-Genís, Antoni
Núñez, Julio
Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title_full Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title_fullStr Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title_full_unstemmed Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title_short Right Ventricular Dysfunction Staging System for Mortality Risk Stratification in Heart Failure with Preserved Ejection Fraction
title_sort right ventricular dysfunction staging system for mortality risk stratification in heart failure with preserved ejection fraction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141269/
https://www.ncbi.nlm.nih.gov/pubmed/32197527
http://dx.doi.org/10.3390/jcm9030831
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