Abstract Body: Background: In heart failure (HF) patients, heterometric adaptation is accompanied by blood volume (BV) expansion, right heart dilatation/dysfunction, and right ventricular-pulmonary arterial (RV-PA) uncoupling. The impact of noninvasive evaluations of RV-PA coupling on outcomes of HF patients is incompletely understood.

Purpose: We hypothesize that BV expansion is associated with myocardial dysfunction, RV-PA arterial uncoupling, and unfavorable outcomes in patients with chronic HF and heterogeneous BV status.

Methods: Patients hospitalized with decompensated HF and who had BV by the indicator-dilution nuclear methodology were included. Patients were considered hypervolemic if BV was ≥25% over expected. The primary endpoint was the composite of all-cause mortality or heart transplantation. The closest TTE to the time of BV was used to measure various indexes of myocardial performance. In addition to standard echo parameters, global and chamber-specific strain parameters were measured with a commercially available software package.

Results: A total of 65 patients were enrolled in the study. There were 44 events (32 deaths, 12 heart transplants) after a median follow-up of 43 months (IQR 14-65). Our main findings were: 1) the majority of the strain parameters and considered echo surrogates of RV-PA coupling were related to the adverse outcomes at Cox proportional hazards analysis (Table 1); 2) at multivariate analysis for TBV model right atrial reservoir strain (RARS) as well as ratio of RARS/SPAP and FWLS/SPAP were independently associated with the primary outcome; 3) all studied parameters of RV-PA uncoupling can be considered as the long-term predictors of worse clinical outcomes; 4) in the Kaplan–Meier survival analysis, RARS and RASR/SPAP (Figure 1) demonstrated notable predictive capability among the evaluated parameters.

Conclusion: An expansion of intravascular and interstitial compartments accompanied by BV redistribution from venous reservoirs, right atrium reservoir function alterations, and right ventricular-pulmonary arterial uncoupling increased the risk of the primary endpoint of all-cause mortality or heart transplantation. Reduced right atrium function affects the left ventricular preload, cardiac output and systolic right ventricular function. Right atrial strain reservoir and right ventricular-pulmonary arterial uncoupling showed the highest predictive value in patients with chronic heart failure and heterogeneous blood volume status