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

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.

Acute Effects of Sildenafil and Dobutamine in the Hypertrophic and Failing Right Heart in Vivo

“…Moreover, TAPSE has prognostic value in humans, with heart failure correlating with short-and long-term mortality. [8][9][10] Image analysis was performed offline using EchoPac software (GE Healthcare), with the observer blinded to the source of samples. For each individual measure, 3 consecutive heart cycles were analyzed, and the mean was used as a representative value.…”

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

“…9,32 An important issue concerns the potential role of baseline RV dysfunction in LV reverse remodeling after CRT. In our study, TAPSE (Figure 3), a marker of overall RV function 33 and an independent predictor of mortality in HF patients, 34,35 showed an association with echocardiographic response to CRT by multivariate analysis (Figure 2), with responders having higher baseline TAPSE values. RV dysfunction was present in 7% of responders compared to 36% of non-responders, and TAPSE <15 mm was statistically associated with non-response, although TAPSE <17 mm (the cut-point for RV dysfunction in clinical practice) showed no association.…”

A jobb kamrai anatómia és funkció korszerű echokardiográfiás vizsgálata: patológiás és fiziológiás eltérések

“…Ebből következően a funkció becslése is általában csak közve-tett módszerekkel lehetséges: a klinikai gyakorlat leginkább a tricuspidalis anulus M-móddal követett mozgását (TAPSE) és a frakcionális területváltozást (FAC) alkalmazza [3]. Mindkettő technika több ízben bizonyította prognosztikai jelentőségét a jobb szívfél megbetegedése-iben [9][10][11], míg a FAC elfogadható korrelációt mutatott a szív mágneses rezonanciás (MRI) vizsgálatával meghatározott jobb kamrai ejekciós frakcióval is [12]. Fontos azonban kiemelni, hogy a TAPSE csak a jobb kamrai hosszanti kontrakciót reprezentálja, míg a FACszámítás figyelmen kívül hagyja a jobb kamrai kiáramlási traktus térfogatváltozásait, így nem demonstrálják töké-letesen az aktuális kamrafunkciót.…”