Purpose: Development of right heart dysfunction and failure basically affect the clinical course in heart failure (HF) syndrome. Evaluation of exercise ventilator response by cardiopulmonary exercise (CPET) testing provides relevant prognostic correlates. We tested whether combining echo-derived RV function variables and CPET-derived indicators of ventilatory impairment may provide additional insights on the evolving nature of the disease. Methods and Results: A cohort of 459 stable HF patients (NYHA class I-IV; average LVEF: 33±10%) underwent right heart echo-Doppler evaluation with assessment of tricuspid annular systolic excursion (TAPSE) and pulmonary systolic pressure (PASP) as well as CPET with assessment of cardinal variables (peak VO2, VE/VCO2 slope and oscillatory ventilation, EOV) and then prospectively tracked for adverse events. Cox regression and Kaplan-Meier analyses were performed with TAPSE and PASP as individual measures and combining them in ratio form. Overall, TAPSE/PASP was the strongest predictor while NYHA class and EOV added significant predictive value. We defined a 4 group distribution based on a simple echocardiographic TAPSE vs PASP rule that identifies risk prediction according to the combined CPET variables’ distribution: Group A (TAPSE> 16 mm and /PASP < 40 mmHg) included patients at lower risk (HR:0.17) and best ventilatory performance; Group B identified subjects still at low risk (HR:0.88) with normal PASP (< 40 mmHg) and some TAPSE reduction (< 16 mm) showing a quite preserved exercise performance but impaired ventilation efficiency. Group C identified those patients that maintained a compensatory TAPSE response (> 16 mm) to increased PASP (> 40 mmHg) with a compromised exercise phenotype, especially exhibiting EOV in a significant rate (HR: 1.3). Group D identified those patients at higher risk with the worse RV-pulmonary pressure uncoupling (TAPSE< 16 and PASP> 40 mmHg), lower overall exercise performance and highest EOV rate (HR: 5.6). Conclusions: Noninvasive echo-derived assessment of RV systolic function proposed under easy-to-perform approach by normalizing TAPSE/PASP provides relevant clinical and prognostic insights tightly combining with abnormal oscillatory ventilation during exercise. Presence of a low TAPSE/PASP and EOV could serve as an indicator of very high risk and a target condition to strictly monitor in HF cohorts.
|Titolo:||Powerlful prognostic and clinical insights combining TAPSE and PASP in heart failure : correlation and additive value with cardiopulmonary exercise response|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||dic-2013|
|Enti collegati al convegno:||European Association of Echocardiography|
|Appare nelle tipologie:||01 - Articolo su periodico|