Study on the prognostic value of dandel's index in elevated pulmonary artery pressure and long-term outcomes in heart failure with preserved ejection fraction (HFpEF)

Elevated pulmonary artery pressure (PAP) is common in heart failure with preserved ejection fraction (HFpEF) and serves as a strong predictor of adverse outcomes. The Dandel index has been used to assess right ventricular (RV) load adaptation, but its role in predicting elevated PAP and long-term prognosis in hypertension-related HFpEF remains unexplored.

From January 2022 to March 2023, 86 HFpEF patients were prospectively enrolled, undergoing both resting and exercise echocardiography. Dandel’s index, tricuspid annular systolic displacement (TAPSE) / pulmonary artery systolic pressure (PASP), RV systolic force (PASP/RVESA), RV free wall strain coupling index (RVFWLS/PASP), and tricuspid annular systolic velocity (TAS') / PASP were calculated. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff points for TAPSE/PASP, RVFWLS/PASP, and Dandel’s index to distinguish HFpEF patients with elevated pulmonary capillary wedge pressure (PCWP) from those without.

At 2-year follow-up, 37% of patients experienced adverse cardiovascular events. In the pulmonary hypertension group, both resting and exercise TAPSE/PASP and RVFWLS/PASP were significantly lower than in the non-pulmonary hypertension group. Resting/exercise RVFWLS/PASP and Dandel’s index were strongly correlated with PCWP (P<0.001). Dandel’s index was significant independent predictor of long-term cardiovascular events (HR 0.73, 95% CI 0.59–0.81, P<0.001).

Dandel's index, reflecting RV-PA coupling, is closely associated with abnormal hemodynamics in HFpEF, particularly elevated PCWP. It is a robust predictor of adverse cardiovascular events in this population.