Right ventricular ejection fraction as predictor of outcome in acute heart failure using RV ellipsoid model: A retrospective analysis of a prospective cross-sectional study

Ashcroft, E; Lazariashvili, Otar; Belsey, Jonathan; Berrill, Max; Sharma, Pankaj; Baltabaeva, Aigul

doi:10.1177/20480040211002775

Cited by 4 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To test the importance of RV function, we applied several other innovative assessments of RV systolic function which are not part of international guidelines. We applied a two-dimensional ellipsoid model to estimate RVEF which has previously been confirmed to be non-inferior to TAPSE and RV FAC in this cohort of patients ( 30 ). In our logistic regression model, it was independently associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

“…RV systolic function assessment parameters included were the tricuspid annular plane systolic excursion (TAPSE); RV Fractional Area Change (RV FAC); RV Tissue Doppler Imaging (TDI) peak systolic wave velocity (RV S’); two-dimensional RV ellipsoid ejection fraction (RVEF) ( 30 ); RV Global Longitudinal Strain (RV GLS), and mean strain rate (RV GLSR) as well as the TAPSE to Systolic Pulmonary Artery Pressure Ratio (TAPSE:SPAP).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

Berrill

Ashcroft

Fluck

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

AimThe severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF.MethodsA total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR.ResultsA total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)].ConclusionWith cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

Berrill

Ashcroft

Fluck

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several studies have evaluated the prognostic role of RVEF in HF patients using different modalities and cut-offs to define RVSD ( Table 4 ). 2 , 4 , 6 , 8–12 , 15 , 17–19 …”

Section: Discussionmentioning

confidence: 99%

“…Other modalities have also been used for the evaluation of RV function, such as radionuclide ventriculography, 2 right heart catheterization, 5 and 3D echocardiography. 6 Cardiac magnetic resonance (CMR), however, is the ‘gold standard’ for volumetric cardiac assessment and quantification due to its high level of spatial resolution, precise definition of anatomy, and excellent reproducibility. 7 Few studies have investigated the prognostic value of CMR-derived RV volumetric parameters in HF with reduced EF (HFrEF).…”

Section: Introductionmentioning

confidence: 99%

Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

Al’Aref

Altibi

Malkawi

et al. 2022

European Heart Journal - Cardiovascular Imaging

View full text Add to dashboard Cite

Aims Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF). Methods and results Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan–Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560–1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09–1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function. Conclusion RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.

show abstract

“…[ 22 ] We defined RVD as TAPSE < 17 mm, RV S' < 9.5 cm/s and/or RV FAC < 35%, and it was significantly associated with a worse primary composite outcome (CV death and HHF). Similarly, Ashcroft et al [ 23 ] study on 418 AHF patients showed that the parameters of RV function, including TAPSE and RV FAC, were predictors of poor outcomes, namely all-cause mortality, which was the primary endpoint after a two-year-follow-up period. Awad et al [ 24 ] demonstrated that RV function assessment by FAC, TAPSE, or RV S' also predicted poor outcomes.…”

Section: Right Ventricular Dysfunction In Acute Heart Failurementioning

confidence: 97%

Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure

Shaker,

Taha,

Kandil

et al. 2024

Egypt Heart J

View full text Add to dashboard Cite

Background The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. Results This study comprised 195 patients, aged between 18 and 80 years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1 year due to non-cardiac causes were excluded. The study participants’ mean age was 57.7 ± 10.9 years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV S' < 9.5 cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. Conclusions RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.

show abstract

Right ventricular ejection fraction as predictor of outcome in acute heart failure using RV ellipsoid model: A retrospective analysis of a prospective cross-sectional study

Cited by 4 publications

References 30 publications

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure

Contact Info

Product

Resources

About