Heart failure with preserved left ventricular ejection fraction (HFpEF) is a clinically significant concern. Approximately half of patients with signs and symptoms of heart failure (HF) have preserved left ventricular ejection fraction (LVEF), and it represents the most common presentation in patients over 65 years of age.1,2 HFpEF is associated with high morbidity and mortality. The rehospitalization rate for HF in this patient group is comparable to that observed in individuals with heart failure and reduced ejection fraction (HFrEF), with an estimated 20 % rehospitalization rate within one month of discharge and 50 % at one year following the index event.3, 4, 5 Furthermore, mortality rates, adjusted for comorbidities, are also like those of patients with HFrEF, ranging between 30 % and 40 % annually.4

In contrast to HFrEF, where multiple pharmacological strategies are available, there is less evidence supporting treatments in patients with HFpEF that have shown effectiveness in improving outcomes in this population.6, 7, 8 Therefore, it is crucial to identify new prognostic factors in patients diagnosed with HFpEF that can help guide or direct the development of new therapeutic approaches.

Right ventricular (RV) dysfunction and pulmonary arterial hypertension are established prognostic factors in patients with HFpEF.9,10 The echocardiography TAPSE/PASP ratio, first described by Guazzi et al. in 2013 11 is a useful tool for assessing RV dysfunction as well as evaluating the coupling between the RV and pulmonary circulation. Lower values of this ratio indicate "uncoupling" between the RV and pulmonary circulation. This index has shown greater ability to identify patients with more advanced stages of the disease compared to TAPSE or PASP alone.12

Although the TAPSE/PASP ratio has been validated in different cohorts of HF patients, particularly in those with chronic HFrEF.13,14 There is limited information regarding its prognostic value in elderly patients hospitalized for acute HFpEF. The aim of our study was to evaluate the one-year prognostic value of the TAPSE/PASP ratio, as a surrogate of right ventricle–pulmonary artery (RV-PA) uncoupling, in elderly patients hospitalized for HFpEF.