Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode

Background The prognostic role of decongestion‐related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. Methods and results This prospective observational single‐centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly‐reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion‐related change of cardiac function and morphology. The combined endpoint of 1 year all‐cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion‐related change. The 176 study participants were 83 years old [74–87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups ( P  < 0.004 for all). Decongestion‐related increase in TAPSE independent of the LVEF was associated with improvement of right‐ventricular‐pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33–0.78, P  = 0.002; adjusted HR 0.46 95% CI: 0.33–0.78, P  = 0.001). Conclusions Decongestion‐related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode.