The Effect Of Right Ventricular Function On Pulmonary Congestion In Patients With Acute Decompensated Heart Failure

Objective: Recent study indicates that the occurrence of pulmonary congestion during exercise in patients with heart failure with preserved ejection fraction is related to right ventricular dysfunction and right ventricular-pulmonary artery uncoupling.However,there is little information about the effect of right heart function on pulmonary congestion in patients with acute decompensated heart failure.The purpose of this study is to study the effect of right ventricular function on pulmonary congestion in patients with acute decompensated heart failure,and to explore its possible mechanism.Methods:This study is a prospective single-center cohort study.The age of hospitalization in the Department of Cardiovascular Medicine of Xiangtan Central Hospital from December 2020 to March 2021 due to acute heart failure was ≥18 years old,a previous history of heart failure,and the Patients in the Guidelines for Diagnosis and Treatment of Failure2018.Exclude patients with myocardial infarction,idiopathic pulmonary hypertension,pulmonary hypertension caused by lung disease,nephrotic syndrome,dialysis(hemodialysis and peritoneal dialysis)in the past 6months.Complete the heart and lung ultrasound examination within 6hours of the patient’s admission,collect B-line,tricuspid annular plane systolic excursion(TAPSE),pulmonary artery systolic pressure(PASP),inferior vena cava width(IVC),early peak flow velocity of mitral valve diastolic/early peak movement velocity of mitral ring diastolic(E/e’)and other data.SPSS26.0 was used for data analysis.The correlation between line B and tricuspid annular plane systolic excursion,tricuspid annular plane systolic excursion/pulmonary artery systolic pressure was analyzed by linear correlation,and B line and tricuspid annular plane systolic excursion The correlation between tricuspid annular plane systolic excursion and pulmonary artery systolic pressure was analyzed by multivariate regression analysis to demonstrate the influence of right heart dysfunction on pulmonary congestion.P ﹤ 0.05 indicates that the difference is statistically significant.Results:A total of 104 patients were enrolled.According to TAPSE,patients were divided into 3 groups,T1(TAPSE﹤16mm,n=57),T2(16≤TAPSE≤20mm,n=32),T3(TAPSE﹥20mm,n=15).According to the ratio of TAPSE/PASP,the patients were divided into 3 groups,TP1(TAPSE/PASP﹤0.32,n=41),TP2(0.32≤TAPSE/PASP≤0.44,n=32),TP3(TAPSE/PASP﹥0.44,n =31).1.In the TAPSE grouping,the difference in B lines of the 3 groups of patients was statistically significant(P﹤0.05).2.In the TAPSE/PASP grouping,the B lines difference of the 3 groups was statistically significant(P﹤0.05).3.In the linear correlation analysis,B lines was negatively correlated with TAPSE,r=-0.39,P ﹤ 0.001;it was negatively correlated with TAPSE/PASP,r=-0.44,P﹤0.001.4.In the multivariate regression analysis,TAPSE,TAPSE/PASP were correlated with line B(P﹤0.05).Taking into account the differences in LVEF,E/e’,and NT-pro BNP between T1,T2,T3,TP1,TP2,and TP3 groups,there are differences in age,gender,body mass index,ischemic cardiomyopathy,systolic blood pressure,serum sodium,Glomerular filtration rate,NT-pro BNP,ejection fraction,and E/e’ differences were corrected.After correction,the lower the TAPSE,TAPSE/PASP,the more B-line(P﹤0.05).Conclusion:1.Patients with acute decompensated heart failure and pulmonary congestion with right heart dysfunction are more serious.