Pathophysiologic risk stratification of chronic heart failure: coexisting left atrial and right ventricular damage and the role of pulmonary circulation

Abstract Funding Acknowledgements Type of funding sources: None. Background in heart failure with reduced ejection fraction (HFrEF) the chronic increase filling pressures progressively involves left atrium (LA), pulmonary circulation (PC) and right ventricle (RV), leading to worse outcome. Purpose we investigated prognostic impact either isolate LA impairment, RV dysfunction combined hypertension, or both, HFrEF, using basic advanced echocardiography. Methods 106 outpatients HFrEF were enrolled. Exclusion criteria primary lung disease, non-sinus rhythm, previous cardiac surgery, poor acoustic window. Clinical examination echocardiography performed. Speckle tracking analysis was used measure peak atrial longitudinal strain (PALS) a new marker interaction between PC: absolute free wall strain(fwRVLS)/systolic artery pressure(sPAP). Patients followed for all-cause cardiovascular death (HF) hospitalization. Results 84 eligible patients [mean age: 60.1 ± 11.5; 82% male, mean ventricular (LV EF) 28 5%], 48 reached endpoint. Population divided into 3 groups: Group 1 [PALS≥15 fwRVLS/sPAP ≤ 0.5]; 2 [PALS 15 0.5 PALS≥15 fwRVLS/sPAP≥0.5]; fwRVLS/sPAP≥0.5]. Mean follow-up 3.5 0.3years. The increasing severity groups associated higher volume index (LAVI), New York Heart Association (NYHA) class, mitral regurgitation (MR) tricuspid (TR) grades, lower LV EF, global (GLS), PALS, annular plane systolic excursion (TAPSE), sPAP, fwRVLS RVLS(p < 0.0001). Reduced PALS independent predictors NYHA > at univariate multivariate adjusted age, sex, any events Cox models (Table 1). Kaplan-Meier curves showed clear divergence prediction endpoint (Fig.1), HF Conclusions combination damage could represent transition point end-stage HF, considerably prognosis. Its assessment help risk stratification order provide early treatment. Table Unadjusted hazard ratio [95% CI] Adjusted GLS GLS, LAVi, TR, RVFAC vs 10.61 [4.16-27.06], p 0.0001 10.24 [3.49-30.02], 9.54 [2.95-30.92], = 0.0002 3.90 [1.92-7.93], 3.82 [1.74-8.36], 0.0008 3.78 [1.66-8.61], 0.002 2.72 [1.03-7.20], 0.04 2.69 [0.99-7.25], 0.05 2.53 [0.84-7.58], 0.1 CI, confidence interval; fraction; strain;LAVI, index; MR, regurgitation, Figure. Fig.1