Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure

Abstract

AimsThe purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure. Methods and resultsA total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled. Fifty-nine patients met the primary composite endpoint of cardiac death, urgent heart transplantation, and urgent mechanical circulatory support implantation at 90 days. Pulmonary hypertension failed to predict events, while patients with a low transtricuspid systolic gradient (TR gradient <20 mmHg) showed a worse outcome [hazard ratio (HR) 2.37, 95% confidence interval (CI) 1.12-5.00, P = 0.02]. RV dysfunction [tricuspid annular plane systolic excursion (TAPSE) ≤14 mm] in the presence of a low TR gradient identified patients at higher risk of events (HR 2.97, 95% CI 1.19-7.41, P = 0.02). Multivariate analysis showed as best predictors of outcome low RV contraction pressure index (RVCPI), defined as TAPSE × TR gradient, and high estimated right atrial pressure (eRAP). Adding RVCPI (<400 mm*mmHg) and eRAP (≥20 mmHg) to conventional clinical (ADHERE risk tree and NT-proBNP) and echocardiographic risk evaluation resulted in an increase in net reclassification improvement of +19.1% and +20.1%, respectively (P = 0.01) and in c-statistic from 0.59 to 0.73 (P < 0.01).

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

“…A fundamental component of right heart distribution system is the right ventricle. It is now largely demonstrated that RV dysfunction is common in HF and that its presence contributes to increased morbidity and mortality RV distribution system . As a matter of fact, the poor prognosis in PH‐HF could not be the direct consequence to the remodelling of the pulmonary circulation, but it could be attributed to the detrimental consequence that PH exerts on the right ventricle.…”

“…Chronic PH induces right ventricular (RV) remodelling and might lead to RV failure, which has been shown to be an important prognostic factor in HF . At the late stage of HF, an elevated PVR has been considered a contraindication to heart transplantation as it may induce RV graft failure .…”

Echokardiograficzna ocena prawych jam serca w praktyce klinicznej w świetle zaleceń ekspertów z 2015 roku

“…W zaleceniach podkreśla się, że jest to wskaźnik zależny od funkcji włókien podłużnych mięśnia RV, ale ponieważ objętość wyrzutowa RV w głów-nym stopniu zależy od ich funkcji, to wskaźnik ten dobrze odzwierciedla globalną czynność skurczową RV [16][17][18]. Pomiar nie jest czasochłonny i w mniejszym stopniu (niż powyżej opisywane wskaźniki) zależy od jakości obrazu.…”

Estimation of Right Ventricular Diastolic Function in Patients With Ischemic Heart Disease in Different Age Groups

“…Так, ее наличие позволяет выявлять среди пациентов с хронической сердечной недостаточ-ностью (ХСН) лиц с крайне неблагоприятным про-гнозом -продолжительностью жизни менее 2 лет [1]. При декомпенсации ХСН наилучшими прогностиче-скими критериями были низкий индекс давления со-кращения ПЖ и высокое расчетное давление в правом предсердии (ПП) [2]. У больных с ХСН с сохраненной фракцией выброса левого желудочка (ФВЛЖ) неза-висимая ассоциация с прогнозом выявлена для дис-функции ПЖ (р <0,001) и систолического давления в легочной артерии (ЛА) (р =0,003), но не для лево-желудочковых показателей [3].…”