Residual Pulmonary Hypertension and Clinical Outcomes in Acute Decompensated Heart Failure Patients Stratified By Left Ventricular Ejection Fraction

AIMS: The precise outcomes for patients with residual pulmonary hypertension (PH) following the optimized treatment of acute decompensated heart failure (ADHF) remain poorly understood. This study aimed to investigate the prognostic association of PH, categorized according to left ventricular ejection fraction (LVEF), in hospitalized ADHF patients. METHODS AND RESULTS: The WET-HF registry is a multicentre, prospective cohort ADHF registry. Patients were classified into four groups according to tricuspid regurgitation velocity (TRV) and LVEF. PH was defined as peak TRV >2.8 m/s. The primary endpoint was a composite of all-cause mortality and heart failure (HF) rehospitalization at 2 years. In total, 1702 patients had nonPH-HF with LVEF <50% (n = 689 [40.5%]), PH-HF with LVEF <50% (n = 291 [17.1%]), nonPH-HF with LVEF ≥50% (n = 453 [26.6%]), and PH-HF with LVEF ≥50% (n = 269 [15.8%]). A significant difference in the composite endpoint was observed between patients with and without PH (42.3% vs. 30.4%, p < 0.001), with no significant interaction between PH and LVEF. Notably, in the nonPH-HF group, there were significant differences in clinical outcomes between patients with more than 30% B-type natriuretic peptide (BNP) improvement and those with less (composite endpoint 27.5% vs. 41.8%, p < 0.001; all-cause mortality 9.4% vs. 24.6%, p < 0.001; HF rehospitalization 20.2% vs. 32.8%, p = 0.001). However, no such difference was evident in the PH-HF group. CONCLUSIONS: The prognostic importance of residual PH was comparable across both HF with reduced and preserved ejection fraction patients. While the prognostic significance of BNP improvement on clinical outcomes was attenuated in the presence of residual PH, utilizing residual PH for risk stratification effectively identified patients at increased risk of mortality and rehospitalization following ADHF, irrespective of their LVEF.