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RESEARCH PRODUCT

Right heart dysfunction and readmission risk across left ventricular ejection fraction status in patients with acute heart failure

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Abstract Background Right heart dysfunction (RHD) parameters, such as right ventricular to pulmonary artery uncoupling or significant tricuspid regurgitation (TR) are increasingly important in heart failure (HF), especially in patients with preserved ejection fraction. In this study, we aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF). Methods We included 3,383 consecutive patients discharged for acute HF (AHF). Of them, in 1,435 (42.4%) pulmonary artery systolic pressure (PASP) could not be accurately measured, leaving a final sample size of 1,948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion (TAPSE)/PASP<0.36 and a significant functional TR (n=196, 10.2%). Negative binomial regression analyses were used to evaluate the risk of recurrent admissions. Results At a median follow up of 2.2 years (IQR=0.63–4.71), 3,782 readmissions were registered in 1,296 patients (66.5%). Patients with advanced RHD showed higher rates of readmissions, but only if LVEF≥40% (p<0.001). In multivariable analyses, this differential association persisted for CV and HF recurrent admissions (p-value for interaction=0.016 and p=0.020; respectively). Advanced RHD was independently associated with the risk of recurrent CV and HF admissions if HF with LVEF≥40% (IRR: 1.99, 95% CI: 1.47–2.69, p<0.001; and IRR: 2.02, 95% CI: 1.45–2.81, p<0.001; respectively). In contrast, it was not associated with readmission risks if LVEF<40%. Conclusion Following an admission for AHF, advanced RHD was strongly associated with a higher risk of recurrent CV and HF admissions, but only in patients with LVEF≥40%. Funding Acknowledgement Type of funding sources: None.