Association of right ventricular lateral annular systolic excursion ratio with in-hospital outcomes among patients with heart failure with reduced ejection fraction

Abstract Background/Introduction Heart failure with reduced ejection fraction (HFrEF) remains a leading cause of hospitalisation and mortality worldwide. Right ventricular (RV) dysfunction is a well-established predictor of adverse clinical outcomes. The lateral annular systolic excursion ratio (LASER) is a novel echocardiographic parameter that quantifies fractional shortening between the lateral tricuspid annulus and RV apex, offering a potential tool for assessing RV systolic function. Purpose To evaluate the association between LASER and in-hospital outcomes in patients admitted with HFrEF. Methods This retrospective cohort study included adult patients hospitalised with HFrEF between June 2023 and December 2024. Primary outcomes were all-cause and cardiovascular in-hospital mortality. Secondary outcomes included non-fatal stroke, non-fatal myocardial infarction, and prolonged length of stay. Associations between LASER and outcomes were analysed using logistic regression. The diagnostic performance of LASER was assessed using receiver operating characteristic (ROC) curve analysis. Results A total of 188 patients were included. Clinical factors significantly associated with in-hospital mortality included acute de novo heart failure (p = 0.013), ischaemic aetiology (p = 0.017), chronic kidney disease (p = 0.004), inotropic support (p < 0.001), anaemia (p = 0.001), sinus rhythm (p = 0.049), and lower systolic blood pressure (p = 0.004). Echocardiographic parameters associated with mortality included reduced left ventricular mass index (p = 0.003), relative wall thickness (p = 0.026), left ventricular ejection fraction (p = 0.001), and impaired RV function as indicated by lower TAPSE (p = 0.005), RV s′ (p = 0.025), and LASER (p = 0.035). Lower LASER values were independently associated with increased cardiovascular mortality (OR = 0.2532; 95% CI: 0.0890–0.7203; p = 0.010). While there was a trend towards significance for all-cause mortality, this did not reach statistical significance (p = 0.060). LASER was not significantly associated with secondary outcomes. ROC analysis showed modest discriminative ability for in-hospital survival (AUC = 0.6203). A derived cut-off of 0.1556 yielded high positive predictive value (87.83%), but with limited sensitivity (64.33%), specificity (54.84%), and likelihood ratios (LR+ = 1.42; LR– = 0.65). Conclusion(s) Lower LASER scores were independently associated with in-hospital cardiovascular mortality among patients with HFrEF. However, its modest diagnostic performance limits its application as a standalone prognostic marker. Prospective studies are warranted to further assess its clinical utility and integration into multimodal risk stratification.