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. 2021 Nov 20;10(22):5423.
doi: 10.3390/jcm10225423.

Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction

Andrea Lorenzo Vecchi  1 , Silvia Muccioli  2 , Jacopo Marazzato  1 , Antonella Mancinelli  3 , Attilio Iacovoni  3 , Roberto De Ponti  1
Affiliations

Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction

Andrea Lorenzo Vecchi et al. J Clin Med. .

Abstract

Background: subclinical pulmonary and peripheral congestion is an emerging concept in heart failure, correlated with a worse prognosis. Very few studies have evaluated its prognostic impact in an outpatient setting and its relationship with right-ventricular dysfunction. The study aims to investigate subclinical congestion in chronic heart failure outpatients, exploring the close relationship between the right heart-pulmonary unit and peripheral congestion.

Materials and methods: in this observational study, 104 chronic HF outpatients were enrolled. The degree of congestion and signs of elevated filling pressures of the right ventricle were evaluated by physical examination and a transthoracic ultrasound to define multiparametric right ventricular dysfunction, estimate the right atrial pressure and the pulmonary artery systolic pressure. Outcome data were obtained by scheduled visits and phone calls.

Results: ultrasound signs of congestion were found in 26% of patients and, among this cohort, half of them presented as subclinical, affecting their prognosis, revealing a linear correlation between right ventricular/arterial coupling, the right-chambers size and ultrasound congestion. Right ventricular dysfunction, TAPSE/PAPS ratio, clinical and ultrasound signs of congestion have been confirmed to be useful predictors of outcome.

Conclusions: subclinical congestion is widespread in the heart failure outpatient population, significantly affecting prognosis, especially when right ventricular dysfunction also occurs, suggesting a strict correlation between the heart-pulmonary unit and volume overload.

Keywords: heart failure; right ventricular dysfunction; right ventricular/arterial coupling; subclinical congestion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
US findings, comparison between groups. (A): pulmonary artery systolic pressure. (B): end-diastolic right atrium area. (C): end-diastolic right ventricle area. (D): TAPSE/PAPS ratio. Group “Control”: patients without clinical signs of peripheral congestion nor echographic signs of congestion. Group “SubC” (Sub Clinical congestion): patients with echographic signs of congestion without peripheral clinical congestion. Group “Edema”: patients with peripheral congestion irrespective of echographic findings. #: p value for “SubC” and “Edema” groups vs. “Control” group. *: p value for selected groups.
Figure 2
Figure 2
Correlations between US signs of ventricular/arterial coupling and right chambers volumes vs. congestion. IVC: Inferior Vena Cava.
Figure 3
Figure 3
Primary composite endpoint expressed by Kaplan-Meier curves: (A) combining tertiles of the right ventricular dysfunction and estimated right atrial pressure. (B) in the three main groups: “Control”; “SubC”; “Edema”. RVD: Right Ventricular Dysfunction. SubC: Sub Clinical Congestion. ECHO Congestion: RAP ≥ 13 mmHg according to IVC diameter and collapse ratio.
See this image and copyright information in PMC

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