ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1611772
This article is part of the Research TopicExploring Right-Left Heart Interactions in Cardiovascular Disease: Mechanisms and ImplicationsView all articles
Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation
Provisionally accepted
Călin-Dinu Hădăreanu1
Diana Ruxandra Hădăreanu2*
Despina-Manuela Toader3
Maria-Livia Iovănescu2
Cristina Florescu2Victor-Cornel Raicea2
Ionut Donoiu2- 1Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- 2Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- 3Clinical Emergency County Hospital of Craiova, Craiova, Romania
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Background: In heart failure (HF) with reduced ejection fraction (HFrEF), ventricular secondary mitral regurgitation (V-sMR) leads to progressive impairment of right ventricular (RV) function and adversely affects outcomes. Non-invasive indices of RV-pulmonary artery (RVPA) coupling may offer enhanced prognostic value.We retrospectively evaluated advanced echocardiographic surrogates of RVPA coupling in 104 HFrEF patients with V-sMR.Results: Over a median follow-up of 526 days, 48 patients (46.2%) reached the composite endpoint of rehospitalization for HF decompensation or all-cause mortality. Patients who experienced events had significantly larger RV volumes, lower RV functional indices, and higher systolic pulmonary artery pressure (sPAP) compared with those without events. Among the RVPA coupling measures, the ratio of RV free-wall longitudinal strain (RVFWLS) to sPAP had the highest predictive accuracy (area under the curve 0.730), with an optimal cut-off of 0.46 %/mmHg (71% sensitivity, 69% specificity). Kaplan-Meier analysis showed significantly lower event-free survival for patients with RVFWLS/sPAP < 0.46 %/mmHg (log-rank p=0.001). In multivariable Cox regression analysis, RVFWLS/sPAP (hazard ratio 0.110, 95% confidence interval 0.012-0.992; p=0.049) emerged as an independent predictor of adverse outcomes. The RVFWLS/sPAP ratio, with a cut-off value of 0.46 %/mmHg, is a robust, independent prognostic marker in HFrEF patients with V-sMR.
Keywords: right ventricular to pulmonary artery coupling, right ventricular strain to pulmonary artery pressure, ventricular secondary mitral regurgitation, Heart failure with reduced ejection fraction, prognosis, speckle-tracking echocardiography, three-dimensional echocardiography
Received: 14 Apr 2025; Accepted: 26 Jun 2025.
Copyright: © 2025 Hădăreanu, Hădăreanu, Toader, Iovănescu, Florescu, Raicea and Donoiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Diana Ruxandra Hădăreanu, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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