International journal of cardiology · 2026
Prognostic impact of systolic pulmonary and aortic regurgitation in heart failure with preserved ejection fraction.
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Hsiao Chao-Sheng, Hsiao Shih-Hung, Shiau Jau-Wen, Chiou Kuan-Rau
Аннотация
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) constitutes a heterogeneous syndrome. We examined whether systolic semilunar regurgitation-systolic aortic regurgitation (SAR) and systolic pulmonary regurgitation (SPR)-identifies a high-risk HFpEF phenotype.
METHODS: In this retrospective single-center study, 412 participants admitted with HFpEF in the past 10 years were included and echocardiographies during hospitalization were assessed. Patients were grouped by the presence of SAR and/or SPR on echocardiography. SAR and SPR were quantitatively assessed using the vena contracta width. The endpoint was the 6-year composite of heart failure rehospitalization or cardiovascular mortality.
RESULTS: Of 412 patients, 248 had neither SAR nor SPR, 77 had SAR alone, 53 had SPR alone, and 34 had SAR + SPR. SAR associated with older age, larger aortic dimensions, and higher E/e'; SPR associated with higher pulmonary artery systolic pressures and reduced right ventricular function. Over 6 years, 219 heart failure rehospitalizations and 63 cardiovascular deaths occurred. The vena contracta width of SAR was an independently predictor associated with the composite endpoint (adjusted hazard ratio 1.259 per 1 mm increase, 95% confident interval 1.118-1.417, p < 0.0001), alongside atrial fibrillation and E/e'. Conversely, the vena contracta width of SPR had no significant impact on these events.
CONCLUSION: SAR marks a high-risk HFpEF phenotype. Incorporating SAR into routine echocardiographic reporting may improve risk stratification and guide targeted management.
METHODS: In this retrospective single-center study, 412 participants admitted with HFpEF in the past 10 years were included and echocardiographies during hospitalization were assessed. Patients were grouped by the presence of SAR and/or SPR on echocardiography. SAR and SPR were quantitatively assessed using the vena contracta width. The endpoint was the 6-year composite of heart failure rehospitalization or cardiovascular mortality.
RESULTS: Of 412 patients, 248 had neither SAR nor SPR, 77 had SAR alone, 53 had SPR alone, and 34 had SAR + SPR. SAR associated with older age, larger aortic dimensions, and higher E/e'; SPR associated with higher pulmonary artery systolic pressures and reduced right ventricular function. Over 6 years, 219 heart failure rehospitalizations and 63 cardiovascular deaths occurred. The vena contracta width of SAR was an independently predictor associated with the composite endpoint (adjusted hazard ratio 1.259 per 1 mm increase, 95% confident interval 1.118-1.417, p < 0.0001), alongside atrial fibrillation and E/e'. Conversely, the vena contracta width of SPR had no significant impact on these events.
CONCLUSION: SAR marks a high-risk HFpEF phenotype. Incorporating SAR into routine echocardiographic reporting may improve risk stratification and guide targeted management.