Ventriculo-arterial coupling in acute heart failure: prognostic and therapeutic insights - a systematic review and meta-analysis of multivariable-adjusted data
Abstract
In acute heart failure (AHF), non-invasive ventricular-arterial coupling (VAC) surrogates, including right ventricular-pulmonary arterial (RV-PA) and left ventricular-arterial (LV-Ao) coupling, have emerged as practical bedside indices, but their prognostic significance remains largely unknown systematically. We performed a systematic review and meta-analysis to evaluate the prognostic significance of non-invasive VAC assessment, in patients hospitalized with AHF. Outcomes included all-cause mortality, HF hospitalization, length of hospital stay, use of therapies, the composite of all-cause mortality and HF hospitalization, and in-hospital adverse cardiovascular events. Adjusted hazard ratios (aHRs) and odds ratios (aORs) were pooled using random-effects. Subgroup-analyses were performed according to follow-up duration and left ventricular ejection fraction. Thirty-six studies comprising 36,989 patients were analysed. Twenty-eight studies evaluated RV-PA coupling, predominantly the TAPSE/PASP ratio, and eight evaluated LV-Ao coupling, mainly using non-invasive Ea/Ees estimates. RV-PA uncoupling was independently associated with increased all-cause mortality (aHR 1.90; 95% CI 1.42–2.56; I²=49%), with consistent associations at 12 months (aHR 2.03; 95% CI 1.44–2.85) and long-term follow-up (aHR 1.67; 95% CI 1.06–2.64). Associations with HF hospitalization, hospital stay, and the composite endpoint were directionally consistent but not statistically significant. LV-Ao uncoupling was associated with increased in-hospital adverse cardiovascular events (aOR 1.70; 95% CI 1.29–2.24). Sensitivity analyses confirmed robustness of these findings. RV-PA uncoupling predicts mortality, whereas LV-Ao uncoupling identifies patients at increased risk of in-hospital adverse cardiovascular events, supporting VAC-risk-stratification in AHF and future evaluation of VAC-guided therapeutic strategies.
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BibTeX
@article{guz2026ventriculoarterial,
title = {{Ventriculo-arterial coupling in acute heart failure: prognostic and therapeutic insights - a systematic review and meta-analysis of multivariable-adjusted data}},
author = {Dragos Guz and Daniela Filipescu and Beth Davison and Elena-Laura Antohi and Andrew P Ambrosy and Serban Mihaileanu and Oliviana Geavlete and Sean P Collins and Razvan Radu and Marianna Adamo and Nicolas Girerd and Radu Filipescu and Luca Monzo and Jan Biegus and Gad Cotter and Ovidiu Chioncel},
journal = {Heart Failure Reviews},
year = {2026},
month = oct,
doi = {10.1007/s10741-026-10680-w},
url = {https://hal.univ-lorraine.fr/hal-05789056v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Ventriculo-arterial coupling in acute heart failure: prognostic and therapeutic insights - a systematic review and meta-analysis of multivariable-adjusted data
AU - Dragos Guz
AU - Daniela Filipescu
AU - Beth Davison
AU - Elena-Laura Antohi
AU - Andrew P Ambrosy
AU - Serban Mihaileanu
AU - Oliviana Geavlete
AU - Sean P Collins
AU - Razvan Radu
AU - Marianna Adamo
AU - Nicolas Girerd
AU - Radu Filipescu
AU - Luca Monzo
AU - Jan Biegus
AU - Gad Cotter
AU - Ovidiu Chioncel
PY - 2026
DA - 2026/10/06
JO - Heart Failure Reviews
DO - 10.1007/s10741-026-10680-w
UR - https://hal.univ-lorraine.fr/hal-05789056v1
AB - In acute heart failure (AHF), non-invasive ventricular-arterial coupling (VAC) surrogates, including right ventricular-pulmonary arterial (RV-PA) and left ventricular-arterial (LV-Ao) coupling, have emerged as practical bedside indices, but their prognostic significance remains largely unknown systematically. We performed a systematic review and meta-analysis to evaluate the prognostic significance of non-invasive VAC assessment, in patients hospitalized with AHF. Outcomes included all-cause mortality, HF hospitalization, length of hospital stay, use of therapies, the composite of all-cause mortality and HF hospitalization, and in-hospital adverse cardiovascular events. Adjusted hazard ratios (aHRs) and odds ratios (aORs) were pooled using random-effects. Subgroup-analyses were performed according to follow-up duration and left ventricular ejection fraction. Thirty-six studies comprising 36,989 patients were analysed. Twenty-eight studies evaluated RV-PA coupling, predominantly the TAPSE/PASP ratio, and eight evaluated LV-Ao coupling, mainly using non-invasive Ea/Ees estimates. RV-PA uncoupling was independently associated with increased all-cause mortality (aHR 1.90; 95% CI 1.42–2.56; I²=49%), with consistent associations at 12 months (aHR 2.03; 95% CI 1.44–2.85) and long-term follow-up (aHR 1.67; 95% CI 1.06–2.64). Associations with HF hospitalization, hospital stay, and the composite endpoint were directionally consistent but not statistically significant. LV-Ao uncoupling was associated with increased in-hospital adverse cardiovascular events (aOR 1.70; 95% CI 1.29–2.24). Sensitivity analyses confirmed robustness of these findings. RV-PA uncoupling predicts mortality, whereas LV-Ao uncoupling identifies patients at increased risk of in-hospital adverse cardiovascular events, supporting VAC-risk-stratification in AHF and future evaluation of VAC-guided therapeutic strategies.
SN - 1382-4147
SN - 1573-7322
ER -