The influence of the interaction of right ventricle and pulmonary artery system on the development of adverse outcomes in acute decompensation of chronic heart failure; Влияние взаимодействия правого желудочка и системы легочной артерии на развитие неблагоприятных исходов при острой декомпенсации хронической сердечной недостаточности

Aim. To determine the frequency and prognostic significance of right ventricular-pulmonary artery (RV-PA) uncoupling, in the development of cardiovascular complications in patients with acute decompensation of chronic heart failure (ADCHF). Materials and methods. The prospective single-center observational study included 171 patients with ADCHF. Tricuspid Annular Plane Systolic Excursion (TAPSE)/PA systolic pressure <0.36 mm/mmHg by 2D echocardiography was used as the indicator of the right ventricular-pulmonary artery RV-PA uncoupling. Results. The incidence of RV-PA uncoupling in the general population of patients with ADCHF was 67.2% (n=129). Patients with RV-PA uncoupling had a more severe clinical status. RV-PA uncoupling was associated with male sex (odds ratio, OR 2.6, 95% CI 1.35–5.04; p=0.004), myocardial infarction (OR 2.06, 95% CI 1.04–4.09; p=0.037), and a history of cerebrovascular accident (OR 10.89, 95% CI 1.42–83.55; p=0.005). Echocardiography showed more pronounced deviations in the structural and functional parameters of the right and left heart compartments and a higher PA systolic pressure. In ischemic heart disease, the risk of RV-PA uncoupling increased 2.85 times (95% CI 0.99–8.23; p=0.053), and in diabetes mellitus, it increased 4.31 times (95% CI 1.19–15.56; p=0.026). With an increase in the diameter of the inferior vena cava per unit, the risk of RV-PA uncoupling increased 9.49 times (95% CI 2.17–41.40; p=0.003), and with an increase in the transverse size of the right atrium, it increased 2.83 times (95% CI 1.28–6.26; p=0.010). In patients with RV-PA uncoupling, higher liver density was identified using transient elastography and reduced active and reactive resistance using bioimpedance vector analysis, regardless of right ventricular dysfunction. The effect of the RV-PA uncoupling on the overall hospitalization rate and related to ADCHF was shown. Conclusion. The high frequency, clinical association, and prognostic significance of RV-PA uncoupling support RV-PA assessment in patients with ADCHF. © 2025 Elsevier B.V., All rights reserved.