Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications

Gaetano Ruocco; Filippo Pirrotta; Christian Mingiano; Guido Cavati; Cristina Tavera; Alberto Palazzuoli

doi:10.3390/diagnostics13040692

Pulmonary Artery Systolic Pressure and Cava Vein Status in Acute Heart Failure with Preserved Ejection Fraction: Clinical and Prognostic Implications

Diagnostics (Basel). 2023 Feb 12;13(4):692. doi: 10.3390/diagnostics13040692.

Authors

Gaetano Ruocco¹, Filippo Pirrotta², Christian Mingiano², Guido Cavati², Cristina Tavera³, Alberto Palazzuoli³

Affiliations

¹ Cardiology Unit, "Buon Consiglio" Fatebenefratelli Hospital, 80123 Naples, Italy.
² Internal Medicine Unit, Department of Medical Surgical, Neuro Sciences University of Siena, 53100 Siena, Italy.
³ Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, Le Scotte hospital University of Siena, 53100 Siena, Italy.

Abstract

Background: Peak tricuspid regurgitation (TR) velocity and inferior cava vein (ICV) distention are two recognized features of increased pulmonary artery pressure (PASP) and right atrial pressure, respectively. Both parameters are related to pulmonary and systemic congestion and adverse outcomes. However, few data exist about the assessment of PASP and ICV in acute patients affected by heart failure with preserved ejection fraction (HFpEF). Thus, we investigated the relationship existing among clinical and echocardiographic features of congestion, and we analyzed the prognostic impact of PASP and ICV in acute HFpEF patients.

Methods and results: We analyzed clinical congestion PASP and ICV value in consecutive patients admitted in our ward by echocardiographic examination using peak Doppler velocity tricuspid regurgitation and ICV diameter and collapse for the assessment of PASP and ICV dimension, respectively. A total of 173 HFpEF patients were included in the analysis. The median age was 81 and median left ventricular ejection fraction (LVEF) was 55% [50-57]. Mean values of PASP was 45 mmHg [35-55] and mean ICV was 22 [20-24] mm. Patients with adverse events during follow-up showed significantly higher values of PASP (50 [35-55] vs. 40 [35-48] mmHg, (p = 0.005) and increased values of ICV (24 [22-25] vs. 22 [20-23] mm, p < 0.001). Multivariable analysis showed prognostic power of ICV dilatation (HR 3.22 [1.58-6.55], p = 0.001) and clinical congestion score ≥ 2 (HR 2.35 [1.12-4.93], p = 0.023), but PASP increase did not reach statistical significance (p = 0.874). The combination of PASP > 40 mmHg and ICV > 21 mm was capable of identifying patients with increased events (45% vs. 20%).

Conclusions: ICV dilatation provides additional prognostic information with respect to PASP in patients with acute HFpEF. A combined model adding PASP and ICV assessment to clinical evaluation is a useful tool for predicting HF related events.

Keywords: HFpEF; acute heart failure; congestion; inferior cave vein; pulmonary artery systolic pressure.

Grants and funding

This research received no external funding.