Objective: Right ventricular dysfunction (RVD) is common in patients with heart failure (HF) with reduced ejection fraction and may lead to cardio-hepatic syndrome (CHS). The present study investigates the prevalence and prognostic impact of CHS and RVD in heart failure with mildly reduced ejection fraction (HFmrEF).
Background: Data investigating the prognostic impact of CHS and RVD in patients with HFmrEF are scarce.
Methods: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. The prognostic impact of CHS (≥2 increased cholestasis parameters), as well as RVD assessed by tricuspid plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and right ventricular fractional area change (RV FAC) was investigated regarding the risk of all-cause mortality and HF-related rehospitalization at 30 months.
Results: 794 HFmrEF patients were included of whom 20.3% suffered from CHS and up to 20.9% from RVD. The CHS was independently associated with a higher risk of 30-months all-cause mortality (adjusted hazard ratio (aHR)=1.340; 95% confidence interval (CI) 1.007-1.782; p=0.045). In line, RVD assessed by the TAPSE (<17mm: aHR=1.704; 95% CI 1.234-2.351; p=0.001) and the TAPSE/PASP (<0.36mm/mmHg: aHR=1.994; 95% CI 1.319-3.015; p=0.001), but not the RV FAC (<35%: aHR=1.003; 95% CI 0.747-.347; p=0.984) predicted the risk of the primary endpoint, which was specifically observed in patients without concomitant CHS. Finally, neither the CHS, nor RVD were associated with the risk of HF-related rehospitalization.
Conclusion: CHS and RVD are prevalent in 20% of patients with HFmrEF and independently associated with increased long-term all-cause mortality.
