射血分数保留的老年心力衰竭住院患者右心室-肺动脉解耦的预后价值

Prognostic value of right ventricle-pulmonary artery uncoupling in elderly patients hospitalized for heart failure with preserved ejection fraction.

作者信息

Decotto Santiago, Fernandez Villar Gonzalo, Rossi Emiliano, Iroulart Juan Maria, Bergier Mariano, Del Castillo Santiago, Perez de Arenaza Diego, Lillo Ezequiel, Bluro Ignacio M, Falconi Mariano L, Belziti Cesar, Pizarro Rodolfo

机构信息

Cardiology Department, Hospital Italiano de Buenos Aires, Argentina.

出版信息

Curr Probl Cardiol. 2025 Sep;50(9):103126. doi: 10.1016/j.cpcardiol.2025.103126. Epub 2025 Jun 30.

DOI:10.1016/j.cpcardiol.2025.103126

PMID:40602737

Abstract

BACKGROUND

The TAPSE/PASP ratio reflects right ventricle-pulmonary artery (RV-PA) coupling and has prognostic value in patients with heart failure, regardless of left ventricular ejection fraction (LVEF). The objective of this study was to assess the prognostic impact of the TAPSE/PASP ratio in elderly patients hospitalized for acute heart failure with preserved ejection fraction (HFpEF).

METHODS

Prospective, observational, and single-center cohort study included patients aged ≥75 years, hospitalized for HFpEF (LVEF >50 %) from September 2019 to December 2023. We excluded patients with significant left-sided valvular disease, advanced renal failure, recent myocardial infarction, and pacemaker users. We defined RV-PA uncoupling as a TAPSE/PASP ratio ≤0.40 using ROC analysis and the Youden index. The primary endpoint was a composite of all-cause mortality and HF rehospitalization at one year.

RESULTS

We included a total of 142 patients. The median age was 84 [IQR 78-88] years, and 65 % (n = 92) were female. The mean LVEF was 56 % (±4 %), and 37 % (n = 53) had RV-PA uncoupling. Patients with uncoupling had higher NT-proBNP (5300 [3107-7257] vs. 2740 [1300-5857] pg/dL; p = 0.01) and troponin levels (48 [32-100] vs. 33 [19-61] pg/dL; p = 0.02), along with worse RV function compared to patients without RV-PA uncoupling. The primary endpoint occurred more frequently in patients with RV/PA uncoupling (62 % vs. 33 %; p = 0.001). In the Cox multivariate analysis, RV-PA uncoupling was independently associated with the primary endpoint (HR 2.37; 95 % CI 1.38-4.07; p = 0.02), after adjusting for age and NT-proBNP levels.

CONCLUSION

In elderly patients hospitalized for HFpEF, RV-PA uncoupling, defined by a TAPSE/PASP ratio ≤ 0.40 was significantly associated with worse outcomes during one-year follow-up.

摘要

背景

三尖瓣环平面收缩期位移/肺动脉收缩压（TAPSE/PASP）比值反映右心室-肺动脉（RV-PA）耦联情况，对心力衰竭患者具有预后价值，无论其左心室射血分数（LVEF）如何。本研究的目的是评估TAPSE/PASP比值对因射血分数保留的急性心力衰竭（HFpEF）住院的老年患者的预后影响。

方法

前瞻性、观察性单中心队列研究纳入了2019年9月至2023年12月期间因HFpEF（LVEF>50%）住院的≥75岁患者。我们排除了有严重左侧瓣膜病、晚期肾衰竭、近期心肌梗死的患者以及起搏器使用者。我们使用ROC分析和尤登指数将RV-PA解耦定义为TAPSE/PASP比值≤0.40。主要终点是1年内全因死亡率和心力衰竭再住院的复合终点。

结果

我们共纳入了142例患者。中位年龄为84岁[四分位间距78-88岁]，65%（n = 92）为女性。平均LVEF为56%（±4%），37%（n = 53）存在RV-PA解耦。与无RV-PA解耦的患者相比，解耦患者的N末端B型利钠肽原（NT-proBNP）水平更高（5300[3107-7257] vs. 2740[1300-5857] pg/dL；p = 0.01）、肌钙蛋白水平更高（48[32-100] vs. 33[19-61] pg/dL；p = 0.02），右心室功能更差。RV/PA解耦的患者主要终点发生频率更高（62% vs. 33%；p = 0.001）。在Cox多变量分析中，调整年龄和NT-proBNP水平后,RV-PA解耦与主要终点独立相关（风险比2.37；95%置信区间1.38-4.07；p = 0.02）。