Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction
Stefano Ghio, Marco Guazzi, Angela Beatrice Scardovi, Catherine Klersy, Francesco Clemenza, Erberto Carluccio, Pier Luigi Temporelli, Andrea Rossi, Pompilio Faggiano, Egidio Traversi, Olga Vriz, Frank Lloyd Dini, all investigators, Stefano Ghio, Marco Guazzi, Angela Beatrice Scardovi, Catherine Klersy, Francesco Clemenza, Erberto Carluccio, Pier Luigi Temporelli, Andrea Rossi, Pompilio Faggiano, Egidio Traversi, Olga Vriz, Frank Lloyd Dini, all investigators
Abstract
Aims: To evaluate whether the clinical and echocardiographic correlates and the prognostic significance of right ventricular (RV) dysfunction are different in heart failure patients with reduced (HFrEF), mid-range (HFmrEF), or preserved (HFpEF) left ventricular ejection fraction.
Methods and results: The study included 1663 patients with heart failure caused by ischaemic or hypertensive heart disease or by idiopathic cardiomyopathy. Left ventricular ejection fraction was <40% in 1123 patients (HFrEF), 40-49% in 156 patients (HFmrEF) and ≥50% in 384 patients (HFpEF). Imaging of the right ventricle was performed by echocardiography; RV function was defined on the basis of tricuspid annular plane systolic excursion (TAPSE) and its normalization for pulmonary artery systolic pressure (PASP). All-cause mortality was the endpoint of survival analysis. Non-sinus rhythm, high heart rate, ischaemic aetiology and E-wave deceleration time <140 ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40 mmHg was by far the strongest correlate of a reduced TAPSE in HFpEF and HFmrEF patients (interaction analysis, P = 0.0011). TAPSE/PASP proved to be a powerful predictor of prognosis in all patients.
Conclusions: The correlates of RV dysfunction differ in HFrEF compared with HFpEF and HFmrEF patients. Regardless of the extent of LV dysfunction, the TAPSE/PASP ratio is a powerful independent predictor of prognosis in all heart failure patients.
Keywords: Echocardiography; Heart failure; Pulmonary hypertension; Right ventricle.
© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.
Source: PubMed