Objetivos
1.To determine the incidence of pulmonary hypertension in patients with ischemic chronic heart failure (PH-iСHF) and various left ventricular ejection fraction (LVEF). 2. To establish the clinical phenotypes based on clinical manifestations, right ventricular-arterial coupling (RVAC) assessed by echocardiography (Echo) and the blood level of NT-proBNP in the studied cohort of patients. 3. To study the effects of physical stress on the right heart in patients with PH-iCHF through the 6-minute walk test (6WT). 4. To determine the prognostic value of right ventricular dysfunction and RVAC in patients with PH-iСHF in the long-term follow-up period.

Materiales y Métodos
69 stable patients from 45 years old with PH-iCHF and different LVEF were examined. Other etiopathogenetic forms of PH as well as the non-ischemic genesis of CHF were excluded. The increased pulmonary artery systolic pressure (sPAP)>30 mmHg according to Echo was considered as PH. RVAC was presented as a classical ratio of TAPSE/sPAP, based on which 3 clinical phenotypes were established by using ROC analysis: patients with severe <0.28 mm/mmHg, moderate ≥0.28 and ≤0.47 mm/mmHg and mild >0.47 mm/mmHg RVAC dissociation. An alternative RVAC (aRVAC) index considered as TAPSE×pACT (pulmonary artery acceleration time) has been additionally studied. The effects of the 6WT on the Echo parameters were observed. The follow-up period lasted for 13,2±0,9 months and ended up with a second check-up.

Resultados
PH develops in 4.1% of CHF cases, among which PH-iCHF is observed in 86.3%. Severe RVAC dissociation is associated with more severe clinical manifestations, the more vivid signs of right heart overload (sPAP 64.7±9.5 mmHg, TAPSE 13.9±1.7 mm, the right atrium area 25±8 cm2, the right ventricle size 4.08±0.88 cm, the inferior vena cava diameter 2.36±0.5 cm, NTproBNP level 4678±3195 pg/ml), decreased LVEF (39.1±11.4%) and functional capacity (6WT distance 267.2±107.4 m), as well as a longer period of inpatient treatment (9.9 ±4.9 days) in comparison to the moderate and mild RVAC dissociation (p<0.05). There is a strong correlation between RVAC and aRVAC indexes (p<0.001). sPAP, TAPSE, pACT and aRVAC levels increases right after the 6WT (p<0.001). The threshold values of sPAP≥40 mmHg, TAPSE ≤18 mm, RVAC ≤0.47 or ≥0.28 mm/mmHg, the right atrium area ≥18 cm2 and the right ventricle size ≥3.5 cm can be used to predict the outcome in the long-term follow-up period. RVAC≥0.28 mm/mmHg has a 86% sensitivity and a 41% specificity as an outcome marker.

Conclusiones
In patients with PH-iCHF the assessment of the right heart and RVAC has a significant diagnostic value for a more complete patient's state estimation. Both TAPSE/sPAP and TARSE×pACT can be used to assess RVAC noninvasively. RVAC≥0.28 mm/mm/Hg can be considered as an outcome predictor during a long term follow-up period.