Right Ventricular Dysfunction for Prediction of Long-Term Recovery in de novo HFrEF : A PROLONG-II Substudy

Jakstaite, AM; Mueller-Leisse, J; Hillmann, HAK; Hohmann, S; Eiringhaus, J; Bavendiek, U; Kempf, T; Veltmann, C; Bauersachs, J; Duncker, D; Berliner, D

doi:10.1002/ehf2.15236

Heart failure & cardiomyopathies

Right Ventricular Dysfunction for Prediction of Long-Term Recovery in de novo Heart Failure with Reduced Ejection Fraction (HFrEF) : A PROLONG-II Substudy

ESC Heart FailPublished 4 Feb 2025PROLONG-II substudy

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Authors' conclusion

Persistent RV dysfunction, as indicated by both standard and advanced echocardiographic markers during the early follow-up period, implies a reduced potential for long-term LV recovery in patients with newly diagnosed HFrEF.

Study context

Population: Patients with new-onset (de novo) HFrEF receiving a wearable cardioverter-defibrillator, from the PROLONG-II studypatients included (mean age 57 years, 68% men)
Participants: 260 patients

Comparison: Patients with long-term LV ejection fraction (LVEF) improvement vs non-improvers: Right ventricular (RV) function and right ventricular-pulmonary artery (RV-PA) coupling at baseline and 3-month follow-up (early follow-up)
Left ventricular (LV) improvementn = 151

Primary result

As reported in the abstract

LV improvement in the long term · median follow-up 31.5 months (IQR: 18.2-45.4)

Patients with LV improvement

151

58%

Further findings

RVFWS at early follow-up as predictor of later LV recovery

	← Lower ←→ Higher →	Odds ratio (95% CI)	P value
RVFWS at early follow-upMultivariable analysis; independent predictor	0.512	1.078 (1.010–1.150)	P < 0.05
	0.512Odds ratio (log scale)

All-cause mortality with RVFWS/PASP identified RV-PA uncoupling

	← Lower ←→ Higher →	Hazard ratio (95% CI)	P value
RVFWS/PASP identified RV-PA uncouplingHigher risk with uncoupling	0.050.21520	4.64 (1.34–16.09)	P = 0.033
	0.050.21520Hazard ratio (log scale)

RV function and markers of RV-PA coupling · baseline

No significant differences

RV function (RVFWS, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC)) · early follow-up (3 months)

RVFWS: −20.9 ± 4.3 vs. −18.5 ± 5.1%
TAPSE: 19.7 ± 5.1 vs. 17.4 ± 4.9 mm
FAC: 39.7 ± 8.5 vs. 35.2 ± 9.4%
Better RV function in patients with long-term LVEF improvement

All P < 0.01

RV-PA coupling (RVFWS/PASP, TAPSE/PASP, FAC/PASP) · early follow-up

RVFWS/PASP: 0.82 ± 0.35 vs. 0.65 ± 0.35%/mmHg
TAPSE/PASP: 0.71 (0.55-1.00) vs. 0.54 (0.35-0.75) mm/mmHg
FAC/PASP: 1.54 ± 0.61 vs. 1.24 ± 0.75%/mmHg
Worse RV-PA coupling in non-improvers

All P < 0.01

Original publication

Right Ventricular Dysfunction for Prediction of Long-Term Recovery in de novo HFrEF : A PROLONG-II Substudy. ESC Heart Fail. Published 4 February 2025. doi:10.1002/ehf2.15236

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