CONGRESS ABSTRACT

Introduction : Acute heart failure (AHF) is the most common emergency admission in patients above 65 years old. Pulmonary hypertension (PH) is a very common finding in AHF patients. Due to the increase of the afterload, the right ventricle (RV) increases contractility to maintain its coupling with the pulmonary artery (PA). Actually, there are no studies on RV-PA coupling during mechanical circulatory support (MCS) in AHF. Aim of the present study is to evaluate in AHF receiving a MCS the role of TAPSE/PASP parameter on MCS performance (in terms of improving patient's hemodynamic status) and its changes over time during MCS. Methods : We enrolled 116 consecutive patients with AHF in ICU from January 2023 to June 2025. Inclusion criteria were AHF diagnosed by the Framingham criteria (plus elevated natriuretic peptides) on admission. Exclusion criteria were age <18 years, severe valvular disease, acute coronary syndrome with RV failure on admission, life expectancy <12 months due to noncardiac diseases or infections. Results : 116 consecutive patients (77 males [66.4%] and 39 females [33.6%]; age 70 ± 14 years) hospitalized for AHF in our ICU were recruited. Among these patients, 12 received MCS (5 IABP, 6 IMPELLA CP and 1 ECMO A-V). Compared to patients who did not receive MCS, these 12 patients had significantly lower SBP, pH, pO2, P/F ratio, SV and a significantly higher HR, Lac, ICU length of stay and use of inotropes. The Wilcoxon signed-rank test showed that TAPSE/PASP significantly improved in patients receiving MCS (Admission: 0.45 [0.50–0.37]; Discharge: 0.77 [0.81–0.73]; p=0.007). The Spearman’s correlation analysis showed a correlation between TAPSE/PASP and EF (rₛ=0.287, p=0.009), SV (rₛ=0.395, p<0.0001), pH (ₛ=0.223, p=0.047), pO2 (rₛ=0.253, p=0.024), P/F ratio (rₛ=0.308, p=0.005), creatinine (rₛ=-0.461, p<0.0001), Lac (rₛ=-0.309, p=0.005), number of inotropes required (rₛ=-0.342, p=0.002) and CV death (rₛ=-0.411, p<0.0001). Regarding MCS, we found a correlation between MCS use and number of inotropes required (rₛ=0.365, p<0.0001), length of stay in ICU (rₛ=0.288, p=0.004) and SV (rₛ=-0.303, p=0.002). Conclusion : Patients needing MCS, whose severity is expressed by the correlation with SV, need for inotropes and length of stay in the ICU, showed an improvement in RV-PA coupling, which corresponds to an improvement in systemic perfusion parameters. Consequently, the higher the TAPSE/PASP, the lower the risk of CV death during MCS using.