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This study aimed to analyze the risk factors of RV-arterial uncoupling in order to explore novel therapeutic targets in acute HFpEF patients with CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective study included 456 consecutive acute HFpEF patients with CAD. The patients were divided into RV-arterial uncoupling and coupling groups based on the optimal cutoff value, determining from a receiver operating characteristic (ROC) curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE\/PASP). Independent risk factors for RV-arterial uncoupling were identified using logistic regression analysis, and combined diagnosis of RV-arterial uncoupling was constructed. A ROC curve was then drawn to evaluate the influencing factors and the effectiveness of combined diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In acute HFpEF patients with CAD, a TAPSE\/PASP ratio of \u2264\u20090.43 provided good accuracy in identifying patients with RV-arterial uncoupling, with an area under the curve (AUC), 0.701, sensitivity of 58.6%, and specificity of 77.7%. Multivariable logistic regression analysis revealed that E\/e\u00b4 (early diastolic mitral inflow velocity\/early diastolic septal mitral annular tissue velocity), the internal diameter of the inferior vena cava (IVC), history of hypertension, atrial fibrillation, postoperative coronary artery bypass grafting (CABG) and interleukin-6 levels were the independent risk factors for RV-arterial uncoupling in acute HFpEF patients with CAD. Furthermore, left ventricular ejection fraction (LVEF), body mass index (BMI), red blood cell distribution width-standard deviation (RDW-SD), and serum albumin levels were protective factors for RV-arterial uncoupling (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). A combination of 9 common indexes, including E\/e\u00b4, LVEF, IVC, hypertensive history, atrial fibrillation, postoperative CABG, BMI, RDW-SD, and serum albumin, was constructed and this common index was combined with interleukin-6 again to draw a ROC curve together with interleukin-6. The AUCs for the common index, interleukin-6, and the common index combined with interleukin-6 in diagnosing RV-arterial uncoupling were 0.862 (95%\n                      <jats:italic>CI<\/jats:italic>\n                      , 0.817\u20130.899), 0.944 (95%\n                      <jats:italic>CI<\/jats:italic>\n                      , 0.917\u20130.965) and 0.980 (95%\n                      <jats:italic>CI<\/jats:italic>\n                      , 0.957\u20130.993), respectively, with\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001. Pairwise comparisons of these three evaluation methods showed\n                      <jats:italic>P<\/jats:italic>\n                      values all &lt;\u20090.001, with the common index combined with interleukin-6 demonstrating the highest diagnostic efficacy for RV-arterial uncoupling, achieving a sensitivity of 94.8%, a specificity of 91.6%, and an accuracy of 92.9%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In acute HFpEF patients with CAD, E\/e\u00b4, IVC, a history of hypertension, atrial fibrillation, CABG, and interleukin-6 are associated with an increased risk of RV-arterial uncoupling, whereas LVEF, BMI, RDW-SD, and serum albumin levels serve as positive factors. Interleukin-6 plays a significant role in RV-arterial uncoupling, and its clinical value is worthy of attention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-05684-1","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T03:17:34Z","timestamp":1772767054000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors analysis of right ventricular-arterial uncoupling in patients having acute heart failure with preserved ejection fraction accompanied by coronary artery disease"],"prefix":"10.1186","volume":"26","author":[{"given":"Hongdan","family":"Jia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihou","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixiang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"issue":"10431","key":"5684_CR1","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/S0140-6736(23)02756-3","volume":"403","author":"P Campbell","year":"2024","unstructured":"Campbell P, Rutten FH, Lee MM, Hawkins NM, Petrie MC. 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