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.