Right ventricle–pulmonary artery coupling in patients with acute heart failure and its implications in cardiology intensive unit care

Introduction Heart failure is the inability of the heart to ensure a cardiac output sufficient to meet the metabolic demands of the body, under conditions of normal ventricular filling pressures. Acute heart failure refers to the rapid onset of symptoms and/or signs of heart failure, whose severity leads the patient to urgently seek medical attention and hospitalization. Since the right ventricle is extremely sensitive to the acute increase in afterload in the case of acute left heart failure, evaluating the coupling between the right ventricle and the pulmonary artery (RV-PA coupling) could prove prognostically important in such patients. The role of RV-PA coupling, assessed through the echocardiographic estimate of TAPSE/PASP, is well established and codified in chronic heart failure and pulmonary hypertension. However, in acute heart failure and in cardiac intensive care settings, it is still scarcely applied. Study Objectives The study aims to evaluate the role of the TAPSE/PASP ratio as a measure of right ventriculo-arterial coupling in patients with acute heart failure admitted to the cardiac intensive care unit. Materials and Methods This prospective study evaluated 108 consecutive patients with acute heart failure of all causes, admitted to the cardiac intensive care unit. All patients were assessed within 6 hours of admission to the cardiac intensive care unit, at discharge, and after 6 months. Patients underwent clinical evaluation, blood tests, and color-Doppler echocardiography, in order to assess left ventricular function, right ventricular function, and its coupling with the pulmonary artery through the TAPSE/PASP ratio. These data were collected to evaluate the aforementioned objectives. Results In the present study, 180 consecutive patients with a diagnosis of acute heart failure (AHF) were enrolled and evaluated echocardiographically at admission, at discharge, and at 6 months of follow-up. The sample consisted of 115 men and 75 women (mean age 71 ± 12 years), with common comorbidities such as hypertension (61%), hyperlipidemia (61%), and diabetes (34%). The main clinical phenotypes included acute coronary syndrome, cardiogenic shock, pulmonary edema, exacerbation of chronic heart failure, Takotsubo syndrome, and myocarditis. Patients who died during hospitalization (n=8) and follow-up (n=14) showed significantly lower TAPSE/PASP values (0.31 ± 0.05 vs. 0.47 ± 0.15; p < 0.001) compared with survivors, confirming the potential prognostic value of this parameter as a non-invasive surrogate of the Ea/Ees ratio. Significant differences were also observed for mean arterial pressure, stroke volume, TAPSE, and systolic velocity S'. TAPSE/PASP was lower in deceased patients regardless of etiology and clinical presentation. In patients treated with inotropes or mechanical circulatory support, TAPSE/PASP was significantly reduced and associated with higher mortality (p = 0.018). Furthermore, a low TAPSE/PASP value at discharge was correlated with increased post-discharge mortality at 6 months (p = 0.033). Conclusions TAPSE/PASP is confirmed as a practical and reproducible potential prognostic indicator in patients with acute heart failure, useful for improving risk stratification and optimizing therapeutic management, with particular relevance in patients with greater hemodynamic vulnerability.