A clinically relevant prognostic indicator of heart failure with mildly reduced ejection fraction is the mean velocity of the pulmonary artery

Abstract

Abstract Background In heart failure (HF), right ventricular and pulmonary artery coupling (RV-PA) can contribute to stratification of prognosis. The non-invasive measurement of pulmonary vascular resistance (PVR) by cardiovascular magnetic resonance (CMR) has been demonstrated to be prognostic in heart failure. Prior to a significant rise in PVR, RV-PA coupling is altered in HF early. The purpose of this study was to evaluate the prognostic value of mean velocity of the pulmonary artery (mvPA) on CMR in patients with HF with mildly reduced ejection fraction (HFmrEF) and pulmonary hypertension both together and separately. Methods 284 consecutive patients with HFmrEF were included in this retrospective study who were hospitalized and underwent CMR with measurement of RV-PA coupling parameters including mvPA between December 2017 and March 2021. We obtained a baseline data set that included clinical characteristics, laboratory results, and cardiac imaging examinations for patients with HFmrEF who underwent at least two echocardiograms performed three months apart.In order to follow up with patients, a phone interview, clinic visit, or community visit was required.The primary outcome was a composite of deaths due to all causes or rehospitalizations for heart failure. Results It was found that 139 patients met the primary endpoint over the mean follow-up period of 49 months. The optimal cut-off value of mvPA calculated by receiver operating curve(ROC) was 9.05cm/s for the prediction of the primary endpoint.According to Kaplan-Meier survival curves, mvPA ≤ 9.05cm/s was associated with higher mortality (Log-Rank:71.93, p < 0.001).It should be noted that mvPA maintained its prognostic value regardless of RV function or even when mortality and HF readmissions were taken into account separately.MvPA ≤ 9.05 cm/s was an independent prognostic marker, along with ischemic cardiomyopathy, hyponatremia. Conclusions By identifying a high-risk population of patients with preserved RV function, mvPA has confirmed its role as an early prognostic indicator. In this study, mvPA showed promise for stratifying long-term outcomes of patients with HFmrEF, and further research is required to confirm its effectiveness.