Authors:

E Santiago-Vacas¹ , J Lupon¹ , G Gavidia-Bovadilla² , M De Antonio¹ , P Moliner¹ , M Domingo¹ , E Zamora¹ , F Gual-Capllonch¹ , A Teis¹ , J Santesmases¹ , J Nunez³ , S Altimir¹ , P Martin¹ , A Ros¹ , A Bayes-Genis¹ , ¹Germans Trias i Pujol University Hospital - Badalona (Barcelona) - Spain , ²Technological Center of Catalonia, Department of e-Health, Eurecat - Barcelona - Spain , ³University Hospital Clinic of Valencia - Valencia - Spain ,

Background: Heart failure (HF) patients with pulmonary hypertension (PHT) and/or right ventricular dysfunction (RVD) have a worse prognosis. How these two entities evolve in the long-term is not completely elucidated.

Purpose: 1) To assess long-term (up to 15 years) trajectories of systolic pulmonary artery pressure (SPAP) and right ventricular function based on tricuspid annular plane systolic excursion (TAPSE); 2) To describe the prevalence of PHT and RVD longitudinally through this long follow-up period; and 3) To analyse the relationship of these two later entities with mortality and number of HF admissions.

Methods: Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit (baseline), 1, 3, 5, 7, 9, 11, 13 and 15 years. PHT was defined as SPAP =40mmHg and RVD as TAPSE =16mm.

Results: Form August 2001 to July 2017, 1421 patients with SPAP (85%) and TAPSE (46%) data in the initial visit were included. Mean follow-up time was 4.6 ± 3.7 years. In survivors SPAP trajectories showedsignificant changes (p<0.001, both for the linear and for the quadratic term of time). An initial trend to decrease in the firsts years and to increase beyond 7 years observed, showing the global trajectory a clear U shape. Although trajectories of TAPSE showed  statistically significant changes along follow-up (p- values also <0.001) no definite pattern was observed and changes seemed of clinically not relevant magnitude. The initial prevalence of PHT was 62.5% and of RVD 45.1%. Indeed the prevalence of PHT tended to decrease in the first 11 years and to increase later, while RVD initially decreased and remained stable thereafter (Figure). Both PHT and RVD were significantly associated with mortality at baseline: PHT (HR 1.7 [1.4-2], p<0.001), RVD (HR 1.6 [1.2-2.1]; p= 0.001). The combination of both entities (PHT + RVD) showed worse prognosis (HR 1.8 [1.3-2.3], p <0.001). When the analyses were repeated with 1 year SPAP and TAPSE values, the association with mortality was even higher: PHT (HR 2.7 [2.1-3.5]; p <0.001); RVD (HR 2 [1.3-2.8], p <0.001); PHT + RVD (HR 4.4 [2.9-6.6], p <0.001). Remarkably decedents always had higher SPAP in the immediately precedent study period. On the other hand, the presence of PHT (p=0.04) and RVD (p<0.001) at baseline were related to the number of recurrent HF admissions during follow-up.

Conclusions: SPAP showed a U shapetrajectory in the long-term follow-up in HF outpatients, while TAPSE improved mildly initially and remained stable afterwards. The presence of PHT and/or RVD was related to an increase in mortality and HF admissions.