Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure
Abstract Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database...
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| Format: | Article |
| Language: | English |
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Wiley
2021-12-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13581 |
| _version_ | 1811247744262602752 |
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| author | Shih‐Hung Hsiao Chao‐Sheng Hsiao Kuan‐Rau Chiou |
| author_facet | Shih‐Hung Hsiao Chao‐Sheng Hsiao Kuan‐Rau Chiou |
| author_sort | Shih‐Hung Hsiao |
| collection | DOAJ |
| description | Abstract Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome. |
| first_indexed | 2024-04-12T15:15:02Z |
| format | Article |
| id | doaj.art-285d408a7aad45ca89ee3ddba1b26372 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-12T15:15:02Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-285d408a7aad45ca89ee3ddba1b263722022-12-22T03:27:38ZengWileyESC Heart Failure2055-58222021-12-01865121513110.1002/ehf2.13581Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failureShih‐Hung Hsiao0Chao‐Sheng Hsiao1Kuan‐Rau Chiou2Division of Cardiology, Department of Internal Medicine E‐Da Hospital, I‐Shou University Kaohsiung TaiwanDivision of Cardiology, Department of Internal Medicine E‐Da Hospital, I‐Shou University Kaohsiung TaiwanDivision of Cardiology, Department of Internal Medicine, Shuang Ho Hospital Taipei Medical University No. 291, Jhongzheng Road, Jhonghe District New Taipei City 23561 TaiwanAbstract Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.https://doi.org/10.1002/ehf2.13581Systolic pulmonary regurgitationHeart failurePulmonary vascular resistancePrognosis |
| spellingShingle | Shih‐Hung Hsiao Chao‐Sheng Hsiao Kuan‐Rau Chiou Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure ESC Heart Failure Systolic pulmonary regurgitation Heart failure Pulmonary vascular resistance Prognosis |
| title | Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| title_full | Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| title_fullStr | Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| title_full_unstemmed | Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| title_short | Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| title_sort | systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure |
| topic | Systolic pulmonary regurgitation Heart failure Pulmonary vascular resistance Prognosis |
| url | https://doi.org/10.1002/ehf2.13581 |
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