Perbaikan Right Ventricular Pulmonary Arterial Coupling sebagai Prediktor Mortalitas dan Rehospitalisasi pada Pasien Gagal Jantung Akut Nonpreserved Ejection Fraction di Rumah Sakit Adam Malik Medan

Abstract

Objective: To evaluate the improvement in right ventricular–pulmonary artery (RV–PA) coupling; measured by the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP), during hospitalization as a predictor of mortality and rehospitalization within six months after treatment in patients with acute heart failure (AHF) with non-preserved ejection fraction (non-HFpEF) at Adam Malik General Hospital, Medan. Methods: This study was an analytical study with a retrospective cohort design involving patients with AHF non-HFpEF treated at Adam Malik General Hospital between January 2023 and January 2025. RV–PA coupling was assessed using the TAPSE/PASP ratio obtained through transthoracic echocardiography (TTE) at admission and discharge. Statistical analyses were conducted to evaluate the association between changes in the RV–PA coupling and six-month outcomes of mortality and rehospitalization post-discharge. Results: A total of 62 patients were included, predominantly 48 patients (77.4%) were male, with a mean age of 60 years. Hypertension was the most common comorbidity in 41 patients (66.1%), and 48 patients (77.4%) of subjects had a sinus rhythm. The most frequently observed AHF phenotype was acute decompensated heart failure (ADHF) at 30 patients (48.4%). At follow-up, 32 patients (51.6%) experienced mortality or rehospitalization within six months after discharge. Analysis showed that increased TAPSE/PASP, with increase of TAPSE of ≥1 mm or just overall with cutoff 0.39 and 0.53, respectively, was significantly associated with lower rates of 6 months post mortality or rehospitalization. However, multivariate analysis revealed RV-PA coupling improvement as an independent factor in mortality or rehospitalization, with no significant impact of supportive therapy during hospitalization or guideline-directed medical therapy discharge on (GDMT <3 out of 4) on these outcomes. Conclusion: Improvement of RV–PA coupling during hospitalization may serve as a substantial noninvasive predictor of mortality and rehospitalization for 6 months in patients with AHF non-HFpEF. This measurement could be broadly applied in clinical practice to improve risk stratification and guide patient management.