Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation
BackgroundIn heart failure (HF) with reduced ejection fraction (HFrEF), ventricular secondary mitral regurgitation (V-sMR) leads to progressive impairment of right ventricular (RV) function and adversely affects outcomes. Non-invasive indices of RV–pulmonary artery (RVPA) coupling may offer enhanced...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1611772/full |
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| author | Călin-Dinu Hădăreanu Călin-Dinu Hădăreanu Diana-Ruxandra Hădăreanu Diana-Ruxandra Hădăreanu Despina-Manuela Toader Maria-Livia Iovănescu Maria-Livia Iovănescu Cristina Florescu Cristina Florescu Victor-Cornel Raicea Victor-Cornel Raicea Ionuț Donoiu Ionuț Donoiu |
| author_facet | Călin-Dinu Hădăreanu Călin-Dinu Hădăreanu Diana-Ruxandra Hădăreanu Diana-Ruxandra Hădăreanu Despina-Manuela Toader Maria-Livia Iovănescu Maria-Livia Iovănescu Cristina Florescu Cristina Florescu Victor-Cornel Raicea Victor-Cornel Raicea Ionuț Donoiu Ionuț Donoiu |
| author_sort | Călin-Dinu Hădăreanu |
| collection | DOAJ |
| description | BackgroundIn heart failure (HF) with reduced ejection fraction (HFrEF), ventricular secondary mitral regurgitation (V-sMR) leads to progressive impairment of right ventricular (RV) function and adversely affects outcomes. Non-invasive indices of RV–pulmonary artery (RVPA) coupling may offer enhanced prognostic value.MethodsWe retrospectively evaluated advanced echocardiographic surrogates of RVPA coupling in 104 HFrEF patients with V-sMR.ResultsOver a median follow-up of 526 days, 48 patients (46.2%) reached the composite endpoint of rehospitalization for HF decompensation or all-cause mortality. Patients who experienced events had significantly larger RV volumes, lower RV functional indices, and higher systolic pulmonary artery pressure (sPAP) compared with those without events. Among the RVPA coupling measures, the ratio of RV free-wall longitudinal strain (RVFWLS) to sPAP had the highest predictive accuracy (area under the curve 0.730), with an optimal cut-off of 0.46%/mmHg (71% sensitivity, 69% specificity). Kaplan–Meier analysis showed significantly lower event-free survival for patients with RVFWLS/sPAP < 0.46%/mmHg (log-rank p = 0.001). In multivariable Cox regression analysis, RVFWLS/sPAP (hazard ratio 0.110, 95% confidence interval 0.012–0.992; p = 0.049) emerged as an independent predictor of adverse outcomes.ConclusionThe RVFWLS/sPAP ratio, with a cut-off value of 0.46%/mmHg, is a robust, independent prognostic marker in HFrEF patients with V-sMR. |
| format | Article |
| id | doaj-art-82d4decc1f574e46b62f7b7a7ce22feb |
| institution | DOAJ |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-82d4decc1f574e46b62f7b7a7ce22feb2025-08-20T02:43:43ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-07-011210.3389/fcvm.2025.16117721611772Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitationCălin-Dinu Hădăreanu0Călin-Dinu Hădăreanu1Diana-Ruxandra Hădăreanu2Diana-Ruxandra Hădăreanu3Despina-Manuela Toader4Maria-Livia Iovănescu5Maria-Livia Iovănescu6Cristina Florescu7Cristina Florescu8Victor-Cornel Raicea9Victor-Cornel Raicea10Ionuț Donoiu11Ionuț Donoiu12Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiovascular Surgery, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaDepartment of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaDepartment of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaDepartment of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaDepartment of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiology, Filantropia Clinical Hospital of Craiova, Craiova, RomaniaDepartment of Cardiovascular Surgery, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaDepartment of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaDepartment of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, RomaniaBackgroundIn heart failure (HF) with reduced ejection fraction (HFrEF), ventricular secondary mitral regurgitation (V-sMR) leads to progressive impairment of right ventricular (RV) function and adversely affects outcomes. Non-invasive indices of RV–pulmonary artery (RVPA) coupling may offer enhanced prognostic value.MethodsWe retrospectively evaluated advanced echocardiographic surrogates of RVPA coupling in 104 HFrEF patients with V-sMR.ResultsOver a median follow-up of 526 days, 48 patients (46.2%) reached the composite endpoint of rehospitalization for HF decompensation or all-cause mortality. Patients who experienced events had significantly larger RV volumes, lower RV functional indices, and higher systolic pulmonary artery pressure (sPAP) compared with those without events. Among the RVPA coupling measures, the ratio of RV free-wall longitudinal strain (RVFWLS) to sPAP had the highest predictive accuracy (area under the curve 0.730), with an optimal cut-off of 0.46%/mmHg (71% sensitivity, 69% specificity). Kaplan–Meier analysis showed significantly lower event-free survival for patients with RVFWLS/sPAP < 0.46%/mmHg (log-rank p = 0.001). In multivariable Cox regression analysis, RVFWLS/sPAP (hazard ratio 0.110, 95% confidence interval 0.012–0.992; p = 0.049) emerged as an independent predictor of adverse outcomes.ConclusionThe RVFWLS/sPAP ratio, with a cut-off value of 0.46%/mmHg, is a robust, independent prognostic marker in HFrEF patients with V-sMR.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1611772/fullright ventricular to pulmonary artery couplingright ventricular strain to pulmonary artery pressureventricular secondary mitral regurgitationheart failure with reduced ejection fractionprognosisspeckle-tracking echocardiography |
| spellingShingle | Călin-Dinu Hădăreanu Călin-Dinu Hădăreanu Diana-Ruxandra Hădăreanu Diana-Ruxandra Hădăreanu Despina-Manuela Toader Maria-Livia Iovănescu Maria-Livia Iovănescu Cristina Florescu Cristina Florescu Victor-Cornel Raicea Victor-Cornel Raicea Ionuț Donoiu Ionuț Donoiu Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation Frontiers in Cardiovascular Medicine right ventricular to pulmonary artery coupling right ventricular strain to pulmonary artery pressure ventricular secondary mitral regurgitation heart failure with reduced ejection fraction prognosis speckle-tracking echocardiography |
| title | Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| title_full | Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| title_fullStr | Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| title_full_unstemmed | Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| title_short | Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| title_sort | prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation |
| topic | right ventricular to pulmonary artery coupling right ventricular strain to pulmonary artery pressure ventricular secondary mitral regurgitation heart failure with reduced ejection fraction prognosis speckle-tracking echocardiography |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1611772/full |
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