DIAGNOSTICS
Need for Stratification of Heart Failure with Preserved Ejection Fraction Shedding light on RV-PA uncoupling with echocardiography Heart Failure with preserved Ejection Fraction (HFpEF) is a crucial problem among cardiovascular diseases for the lack of established treatment strategies. There must be a need for detailed observational cohort studies for HFpEF patients to elucidate the detailed clinical phenotypes and to find appropriate therapeutic strategies. Akito Nakagawa, Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital
H
eart Failure (HF) is a critical social problem all over the world, and HF with preserved Ejection Fraction (HFpEF) has particularly been increasing and upcoming to a bothering issue. Complicated pathophysiology and multiple comorbidities with an aging population makes it rather difficult to find the best way to treat HFpEF patients, and none of specific strategies have been established for the prognostic improvement. In order to understand the characteristics, backgrounds, and underlying problems of current HFpEF patients, we considered detailed observational cohort study must be needed. Based on such a concept, professor Yasushi Sakata (Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan) launched multi-centre observational cohort study, named PURSUIT-HFpEF registry, from June
2016 to register up to 1,500 HFpEF patients until March 2021. Inclusion criteria were acute decompensated HFpEF diagnosed by the Framingham criteria for HF plus the following: (1) left ventricular ejection fraction ≥ 50 per cent and (2) N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥ 400 pg/mL or brain natriuretic peptide (BNP) ≥ 100 pg/mL on admission. Exclusion criteria were age < 20 years, severe valvular disease, acute coronary syndrome on admission, life expectancy of < 6 months due to prognosis of non-cardiac diseases, and previous heart transplantation. Importance of right heart function among HFpEF patients
Although Right Ventricular (RV) function had been de-emphasised in the consideration of left-sided HF for many years, it is now evident that RV dysfunction is highly prevalent and resulted in poor prognosis in patients
with left-sided HF with HFpEF in the position statement of the Heart Failure Association of the European Society of Cardiology. Even among the parameters related to right heart dysfunction and failure, RV-Pulmonary Artery (PA) coupling has been extensively focused on the prognostic predictability. Right ventricle is quite sensitive to changes in afterload, and the afterload dependence is even exaggerated in HFpEF patients. Although RV-PA coupling had been evaluated with invasive calculation with Swan-Ganz catheterisation, recent studies have revealed that RV-PA coupling was able to be examined in a non-invasive manner with Tricuspid Annular Plane Systolic Excursion (TAPSE) to Pulmonary Arterial Systolic Pressure (PASP) ratio on echocardiography. TAPSE represents right ventricular contractile function, and PASP is estimated with the pressure gradient of tricuspid
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