Risk factors analysis of right ventricular-arterial uncoupling in patients having acute heart failure with preserved ejection fraction accompanied by coronary artery disease.

BACKGROUND: Right ventricular (RV)-arterial uncoupling is highly prevalent in patients having acute heart failure with preserved ejection fraction (HFpEF) accompanied by coronary artery disease (CAD), and it serves as a strong predictor of adverse outcomes. This study aimed to analyze the risk factors of RV-arterial uncoupling in order to explore novel therapeutic targets in acute HFpEF patients with CAD. METHODS: This prospective study included 456 consecutive acute HFpEF patients with CAD. The patients were divided into RV-arterial uncoupling and coupling groups based on the optimal cutoff value, determining from a receiver operating characteristic (ROC) curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). Independent risk factors for RV-arterial uncoupling were identified using logistic regression analysis, and combined diagnosis of RV-arterial uncoupling was constructed. A ROC curve was then drawn to evaluate the influencing factors and the effectiveness of combined diagnosis. RESULTS: In acute HFpEF patients with CAD, a TAPSE/PASP ratio of ≤ 0.43 provided good accuracy in identifying patients with RV-arterial uncoupling, with an area under the curve (AUC), 0.701, sensitivity of 58.6%, and specificity of 77.7%. Multivariable logistic regression analysis revealed that E/e´ (early diastolic mitral inflow velocity/early diastolic septal mitral annular tissue velocity), the internal diameter of the inferior vena cava (IVC), history of hypertension, atrial fibrillation, postoperative coronary artery bypass grafting (CABG) and interleukin-6 levels were the independent risk factors for RV-arterial uncoupling in acute HFpEF patients with CAD. Furthermore, left ventricular ejection fraction (LVEF), body mass index (BMI), red blood cell distribution width-standard deviation (RDW-SD), and serum albumin levels were protective factors for RV-arterial uncoupling (P < 0.05). A combination of 9 common indexes, including E/e´, LVEF, IVC, hypertensive history, atrial fibrillation, postoperative CABG, BMI, RDW-SD, and serum albumin, was constructed and this common index was combined with interleukin-6 again to draw a ROC curve together with interleukin-6. The AUCs for the common index, interleukin-6, and the common index combined with interleukin-6 in diagnosing RV-arterial uncoupling were 0.862 (95% CI, 0.817–0.899), 0.944 (95% CI, 0.917–0.965) and 0.980 (95% CI, 0.957–0.993), respectively, with P < 0.001. Pairwise comparisons of these three evaluation methods showed P values all < 0.001, with the common index combined with interleukin-6 demonstrating the highest diagnostic efficacy for RV-arterial uncoupling, achieving a sensitivity of 94.8%, a specificity of 91.6%, and an accuracy of 92.9%. CONCLUSIONS: In acute HFpEF patients with CAD, E/e´, IVC, a history of hypertension, atrial fibrillation, CABG, and interleukin-6 are associated with an increased risk of RV-arterial uncoupling, whereas LVEF, BMI, RDW-SD, and serum albumin levels serve as positive factors. Interleukin-6 plays a significant role in RV-arterial uncoupling, and its clinical value is worthy of attention.