Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure findings from a pooled analysis of four cohort studies

Kobayashi, M. et al. (2021) Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure findings from a pooled analysis of four cohort studies. Clinical Research in Cardiology, 110(8), pp. 1181-1192. (doi: 10.1007/s00392-020-01724-8) (PMID:32770373)

Abstract

Background: Right ventricular (RV) dysfunction and RV–pulmonary artery (PA) uncoupling are associated with the development of pulmonary congestion during exercise. However, there is limited information regarding the association between these right-sided cardiac parameters and pulmonary congestion in acutely decompensated heart failure (HF). Methods: We performed an individual patient meta-analysis from four cohort studies of hospitalized patients with HF who had available lung ultrasound (B-lines) data on admission and/or at discharge. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), RV–PA coupling was defined as the ratio of TAPSE to PA systolic pressure (PASP). Results: Admission and discharge cohort included 319 patients (75.8 ± 10.1 years, 46% women) and 221 patients (77.9 ± 9.0 years, 47% women), respectively. Overall, higher TAPSE was associated with higher ejection fraction, lower PASP, b-type natriuretic peptide and B-line counts. By multivariable analysis, worse RV function or RV–PA coupling was associated with higher B-line counts on admission and at discharge, and with a less reduction in B-line counts from admission to discharge. Higher B-line counts at discharge were associated with a higher risk of the composite of all-cause mortality and/or HF re-hospitalization [adjusted-HR 1.13 (1.09–1.16), p < 0.001]. Furthermore, the absolute risk increase related to high B-line counts at discharge was higher in patients with lower TAPSE. Conclusions: In patients with acutely decompensated HF, impaired RV function and RV–PA coupling were associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay. Worse prognosis related to residual pulmonary congestion was enhanced in patients with RV dysfunction.

• Item Type: Articles
• Additional Information: MK was provided a grant by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (ANR-15-RHUS-0004). PR, NG and KD are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (ANR-15-RHUS-0004) and by the FrenchPIA project “Lorraine Université d’Excellence” (ANR-15-IDEX-04-LUE).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pellicori, Dr Pierpaolo
• Authors: Kobayashi, M., Gargani, L., Palazzuoli, A., Ambrosio, G., Bayés-Genis, A., Lupon, J., Pellicori, P., Pugliese, N. R., Reddy, Y. N.V., Ruocco, G., Duarte, K., Huttin, O., Rossignol, P., Coiro, S., and Girerd, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 08 August 2020
• Copyright Holders: Copyright © Springer-Verlag GmbH Germany, part of Springer Nature 2020
• First Published: First published in Clinical Research in Cardiology 110(8): 1181-1192
• Publisher Policy: Reproduced in accordance with the publisher copyright policy