Clinical study: heart failure
Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure

https://doi.org/10.1016/S0735-1097(00)01102-5Get rights and content
Under an Elsevier user license
open archive

Abstract

OBJECTIVES

We sought a better understanding of the coupling between right ventricular ejection fraction (RVEF) and pulmonary artery pressure (PAP), as it might improve the accuracy of the prognostic stratification of patients with heart failure.

BACKGROUND

Despite the long-standing view that systolic function of the right ventricle (RV) is almost exclusively dependent on the afterload that this cardiac chamber must confront, recent studies claim that RV function is an independent prognostic factor in patients with chronic heart failure.

METHODS

Right heart catheterization was performed in 377 consecutive patients with heart failure.

RESULTS

During a median follow-up period of 17 ± 9 months, 105 patients died and 35 underwent urgent heart transplantation. Pulmonary artery pressure and thermodilution-derived RVEF were inversely related (r = 0.66, p < 0.001). However, on Cox multivariate survival analysis, no interaction between such variables was found, and both turned out to be independent prognostic predictors (p < 0.001). It was found that RVEF was preserved in some patients with pulmonary hypertension, and that the prognosis of these patients was similar to that of the patients with normal PAP. In contrast, when PAP was normal, reduced RV function did not carry an additional risk.

CONCLUSIONS

These observations emphasize the necessity of combining the right heart hemodynamic variables with a functional evaluation of the RV when trying to define the individual risk of patients with heart failure.

Abbreviations

LV
left ventricle or ventricular
LVEF
left ventricular ejection fraction
NYHA
New York Heart Association
PAP
pulmonary artery pressure
RV
right ventricle or ventricular
RVEF
right ventricular ejection fraction

Cited by (0)

This study was supported in part by grant 080RFM92/02 from the Italian Health Ministry to IRCCS Policlinico S. Matteo.