BACKGROUND

The objectives of this study were to describe right ventricular-pulmonary arterial elastance coupling hemodynamic phenotypes and their frequency in patients with advanced heart failure and to evaluate the association of elastance-based indices with all-cause mortality, cardiac transplantation, and left ventricular assist device therapy.

METHODS

This study included 175 patients with heart failure undergoing right heart catheterization to evaluate candidacy for advanced therapies and 21 healthy controls. We modified a single-beat approach to elastance to account for the magnitude of pulmonary arterial pressure and estimated right ventricular end-systolic elastance (E_es), pulmonary arterial elastance (E_a), and the E_es:E_a ratio. We defined elevated pulmonary arterial load as an E_a > 0.5 mm Hg/ml, and ventriculo-arterial uncoupling as an E_es:E_a < 0.8. We evaluated associations between E_es, E_a, and E_es:E_a with all-cause mortality and composite event-free survival using multivariable Cox proportional-hazard models, adjusted for age and sex.

RESULTS

All 21 controls had E_a ≤ 0.5 mm Hg/ml and E_es:E_a ≥ 0.8. Of 175 patients with heart failure, 63% had E_a > 0.5 mm Hg/ml. E_es:E_a was lower in patients than in controls (p < 0.001), and 47% of the patients demonstrated E_es:E_a < 0.8, including 8% with normal E_a. In median follow-up of 2.2 (0.8–4.6) years, 53 died, 37 received cardiac transplantation, and 33 received a left ventricular assist device. By multivariable analysis, E_a (hazard ratios [HR]: 2.01, 95% CI 1.18–3.41) and E_es:E_a (HR: 0.46, 95% CI: 0.26–0.82) were independently associated with mortality, whereas E_es was not.

CONCLUSIONS

Right ventricular-pulmonary vascular coupling is frequently impaired in heart failure and associated with greater mortality. Elevated pulmonary arterial elastance is associated with greater mortality even when coupling is preserved.

中文翻译：

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肺动脉弹性增高和右心室解偶联与晚期心力衰竭的较高死亡率相关。

背景

这项研究的目的是描述晚期心力衰竭患者右心室-肺动脉弹性耦合血流动力学表型及其频率，并评估基于弹性的指数与全因死亡率，心脏移植和左心室辅助设备的关联治疗。

方法

这项研究包括175例接受右心导管检查的心力衰竭患者，以评估其对晚期疗法的候选资格以及21个健康对照。我们修改了弹性的单搏方法，以说明肺动脉压的大小以及估计的右心室收缩末期弹性（E _es），肺动脉弹性（E _a）和E _es：E _a比率。我们将升高的肺动脉负荷定义为E _a > 0.5 mm Hg / ml，将心室-动脉解耦定义为E _es：E _a <0.8。我们之间评估协会è _ES，E_一，和ē _ES：电子_一全因死亡率和复合无事件生存率使用多变量Cox比例风险模型，调整后的年龄和性别。

结果

所有21个控制过Ë_一个≤0.5mmHg的/ ml和ë_上课：电子_一个≥0.8。在175名心力衰竭患者中，有63％的E _a > 0.5 mm Hg / ml。E _es：E _a在患者中低于对照组（p <0.001），并且47％的患者表现出E _es：E _a <0.8，包括8％的E _a正常。中位随访期为2.2（0.8-4.6）年，其中53例死亡，37例接受了心脏移植，33例接受了左心室辅助装置。通过多变量分析，E _a（危险比[HR]：2.01，95％CI 1.18-3.41）和E _es：E _a（HR：0.46，95％CI：0.26-0.82）与死亡率独立相关，而E _es与死亡率无关。

结论

右心室-肺血管耦合常因心力衰竭而受损，并伴有更高的死亡率。即使保持偶合，升高的肺动脉弹性也会导致更高的死亡率。