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Purpose: It is well established that the right ventricular dysfunction (RVD) is a powerful predictor of mortality in patients with heart failure. However, the additive prognostic value of RVD and pulmonary artery hypertension (PAH) is not well known. The aim of this study was to evaluate multiple RVD and PAH parameters that allowed an easy risk stratification of patients with symptomatic heart failure and left ventricular dysfunction (LVD) due to either ischemic or idiopathic dilated cardiomyopathy (IDC). Methods: The study included 403 consecutive patients with symptomatic but stable heart failure (NYHA class II-IV) and LVD (mean left ventricular ejection fraction of 25%). Patients underwent clinical and laboratory examination, radionuclide ventriculography and right-sided heart catheterization. A stepwise multivariate Cox proportional hazards analysis was performed to determine independent predictors of the combined endpoint of death or heart transplantation (HT). Results: RVD (defined as right ventricular ejection fraction<35%) was presented in 51% of patients with ischemic cardiomyopathy and 62% with IDC (p=0.56). After a median follow-up of 64 months, there were 54 cardiac deaths and 152 HT. Independent predictors in the multivariate analysis were (p<0.001): NYHA class III-IV HR (IC 95%) 3.53 (2,34-5,34), right ventricular ejection fraction<35% 1.94 (1.29-2.94), median pulmonary artery pressure>30mmHg 1.91 (1.33-2.73). Mortality or heart transplantation risk at 1, 3 and 5 years increased significantly as the number of independent predictors where added, log rank <0.001 (Table 1).