Right Ventricular Free Wall Strain and Congestive Hepatopathy in Patients with Acute Worsening of Chronic Heart Failure: A CATSTAT-HF Echo Substudy

Josip A Borovac, Duska Glavas, Zora Susilovic Grabovac, Daniela Supe Domic, Lada Stanisic, Domenico D'Amario, Darko Duplancic, Josko Bozic, Josip A Borovac, Duska Glavas, Zora Susilovic Grabovac, Daniela Supe Domic, Lada Stanisic, Domenico D'Amario, Darko Duplancic, Josko Bozic

Abstract

Right ventricular (RV) function is an important predictor of prognosis in patients with heart failure. However, the relationship of the RV free wall longitudinal strain (RV FWS) and the degree of hepatic dysfunction during the acute worsening of heart failure (AWHF) is unknown. We sought to determine associations of RV FWS with laboratory liver function tests and parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV FAC), maximal tricuspid jet velocity (TR Vmax), RV S' velocity, and estimated RV systolic pressure (RVSP). A total of 42 AWHF patients from the CATSTAT-HF study were stratified in two groups by the RV FWS median (-16.5%). Patients < RV FWS median had significantly prolonged international normalized ratio (INR; p = 0.002), increased total bilirubin (p < 0.001) and alkaline phosphatase (ALP; p = 0.020), and decreased albumin (p = 0.005) and thrombocytes (p = 0.017) compared to patients > RV FWS median. RV FWS independently correlated to total bilirubin (β = 0.457, p = 0.004), ALP (β = 0.556, p = 0.002), INR (β = 0.392, p = 0.022), albumin (β = -0.437, p = 0.013), and thrombocytes (β = -404, p = 0.038). Similarly, TAPSE, RV FAC, and RV S' significantly correlated with RV FWS. In conclusion, RV impairment, reflected in reduced RV FWS, is independently associated with a higher degree of hepatic dysfunction among patients with AWHF (CATSTAT-HF ClinicalTrials gov number, NCT03389386).

Keywords: echocardiography; heart failure; heart failure decompensation; hepatic insufficiency; laboratory markers; liver dysfunction; right; ventricular dysfunction.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Linear regression plots showing the correlation of right ventricular (RV) free wall longitudinal strain with respect to laboratory parameters reflecting hepatic function and cholestasis. (A) Total bilirubin, (B) alkaline phosphatase, (C) Thrombocyte count, (D) gamma-glutamyl transferase, (E) aspartate aminotransferase, (F) alanine aminotransferase. * Significant statistical association at two-tailed level. r-Pearson’s correlation coefficient.
Figure 2
Figure 2
Linear regression plots showing the correlation of RV free wall longitudinal strain with respect to laboratory parameters that reflect synthetic liver function. (A) albumin, (B) prothrombin time - international normalized ratio. * Significant statistical association at two-tailed level. r-Pearson’s correlation coefficient.
Figure 3
Figure 3
Linear regression plots showing the correlation of RV free wall longitudinal strain with respect to other echocardiographic parameters of RV function and estimated RV systolic pressure in the total patient cohort (n = 42). (A) TAPSE, (B) RV FAC, (C) RV S′, (D) TR Vmax, (E) RVSP. * Significant statistical association at two-tailed level. r-Pearson’s correlation coefficient. Abbreviations: RV FAC-right ventricular fractional area change; RV S′-myocardial systolic excursion velocity; RVSP-right ventricular systolic pressure (estimated); TAPSE-tricuspid annular plane systolic excursion; and TR Vmax-maximal tricuspid regurgitation velocity.

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