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Heart failure & cardiomyopathiesResearch article

Evolution and Prognostic Value of Right Ventricular to Pulmonary Artery Coupling During Guideline-Directed Medical Therapy Up-Titration

Circ Heart FailPublished

  • consecutive patients followed for guideline-directed medical therapy (GDMT) up-titration in a dedicated heart failure (HF) clinic
  • tertiary center
  • echocardiography at baseline and at follow-up
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Authors' conclusion

This study highlights the independent and incremental prognostic value of tricuspid annular plane systolic excursion/systolic pulmonary artery pressure in HF with reduced ejection fraction during GDMT up-titration, suggesting to also consider RV to pulmonary artery coupling with echocardiography as a treatment goal.

Study context

Population
Patients with left ventricular ejection fraction <50% followed for GDMT up-titration in a dedicated HF clinic, January 2019 to June 2022all consecutive patients
Participants
291 patients
Comparison
Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure <0.65 mm/mm Hg at follow-up and the primary end point
Outcome
all-cause death or hospitalization for acute HF
Follow-up
After 2 years

Main finding

As reported in the abstract

Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure <0.65 mm/mm Hg at follow-upHazard ratio (95% CI)P value
adjustment with comorbidities
5.9(2.8–12.1)
P < 0.001
clinical and biological severity
6.4(2.4–17.8)
P < 0.001
echocardiography
3.6(1.6–8.4)
P = 0.002
patients reached the primary end point
49 patients (17%)

Further findings

Right ventricular (RV) to pulmonary artery coupling (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) · after GDMT up-titration

baseline versus follow-up
0.62 versus 0.81 mm/mm Hg
P
P < 0.001
RV size and function significantly improved (all)
P < 0.001

Incremental prognostic value of tricuspid annular plane systolic excursion/systolic pulmonary artery pressure

C-index improvement
P < 0.01
  • over and above prognostic factors, including left ventricular ejection fraction

Baseline characteristics

median age
65 (55-74) years
female
24%
Ischemic cardiomyopathy
47%
left ventricular ejection fraction
30% (22%-34%)

Original publication

Evolution and Prognostic Value of Right Ventricular to Pulmonary Artery Coupling During Guideline-Directed Medical Therapy Up-Titration. Circ Heart Fail. Published 7 January 2026. doi:10.1161/circheartfailure.125.012980
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Summarised from the published abstract; every number is checked against it