Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure

Eur J Heart Fail. Jun-Jul 2007;9(6-7):610-6. doi: 10.1016/j.ejheart.2007.03.001. Epub 2007 Apr 25.

Abstract

Background: The prognostic importance of right ventricular (RV) dysfunction in heart failure (HF) has been suggested in patients with severe systolic heart failure. Tricuspid annular plane systolic excursion (TAPSE) is a simple echocardiographic measure of RV ejection fraction, but may be affected by co-existing chronic obstructive pulmonary disease (COPD).

Aims: To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF.

Methods and results: Eight hundred and seventeen patients screened for participation in a large clinical trial by trans-thoracic echocardiography, including measurement of TAPSE, were followed for a median of 4.1 years (maximum 5.5 years). Decreased TAPSE as well as presence of COPD were independently associated with adverse short- and long-term survival, hazard ratio was 0.74 (p=0.004) for every doubling of TAPSE; and 2.4 (p<0.0001) for the presence of COPD.

Conclusion: Decreased RV systolic function as estimated by TAPSE is associated with increased mortality in patients admitted for HF, and is independent of other risk factors in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-Agonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Cardiotonic Agents / therapeutic use
  • Comorbidity
  • Dopamine Agonists / therapeutic use
  • Echocardiography
  • Esters / therapeutic use
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnostic imaging
  • Heart Failure / drug therapy
  • Heart Failure / mortality*
  • Humans
  • Male
  • Myocardial Contraction / physiology
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Risk Factors
  • Stroke Volume
  • Survival Analysis
  • Tetrahydronaphthalenes / therapeutic use
  • Tricuspid Valve / diagnostic imaging
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / drug therapy
  • Ventricular Dysfunction, Right / mortality*

Substances

  • Adrenergic alpha-Agonists
  • Cardiotonic Agents
  • Dopamine Agonists
  • Esters
  • Tetrahydronaphthalenes
  • nolomirole