The cardio-hepatic syndrome and right ventricular dysfunction in heart failure with mildly reduced ejection fraction.

Abstract

OBJECTIVE: Right ventricular dysfunction (RVD) is common in patients with heart failure (HF) and reduced ejection fraction and may lead to cardio-hepatic syndrome (CHS). The present study investigates the prevalence and prognostic impact of CHS and RVD in heart failure with mildly reduced ejection fraction (HFmrEF). BACKGROUND: Data investigating the prognostic impact of CHS and RVD in patients with HFmrEF are scarce. METHODS: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of CHS (≥2 increased cholestasis parameters), as well as RVD assessed by tricuspid plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and right ventricular fractional area change (RV FAC) was investigated regarding the risk of all-cause mortality and HF-related rehospitalization at 30 months. RESULTS: 794 HFmrEF patients were included of whom 20.3% suffered from CHS and up to 20.9% from RVD. At 30 months, the CHS was not associated the risk of 30-months all-cause mortality (adjusted hazard ratio (aHR)=1.316; 95% confidence interval (CI) 0.990-1.751; p=0.059). In contrast, RVD assessed by the TAPSE (< 17mm; aHR=1.482; 95% CI 1.126-1.951; p=0.005) and the TAPSE/PASP (<0.36mm/mmHg; aHR=1.566; 95% CI 1.092-2.245; p=0.015) predicted the risk of the primary endpoint. Finally, neither the CHS, nor RVD were associated with the risk of HF-related rehospitalization. CONCLUSION: CHS and RVD are prevalent in 20% of patients with HFmrEF, whereas the TAPSE or TASPE/PASP were independently associated with increased all-cause mortality. In HFmrEF patients, RVD may carry greater prognostic significance as compared to the CHS.