Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure

Groote, Pascal de; Millaire, A; Foucher-Hossein, Claude; Nugue, Olivier; Marchandise, X.; Ducloux, G; Lablanche, Jean‐Marc

doi:10.1016/s0735-1097(98)00337-4

Cited by 589 publications

(300 citation statements)

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“…In humans, right heart assessment has been shown to have a clinically relevant impact on predicting clinical status and outcome in a variety of cardiovascular diseases, including diseases conventionally viewed as left heart‐specific, such as mitral valve disease and HCM 12, 23, 24, 25, 26. Recently, RV function has also been shown to have prognostic value in dogs with arrhythmogenic RV cardiomyopathy and myxomatous mitral valve disease 27, 28.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

Visser

Sloan

Stern

2017

Veterinary Internal Medicne

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BackgroundStudies evaluating right ventricular (RV) structural and functional abnormalities in feline hypertrophic cardiomyopathy (HCM) are limited.HypothesisRight ventricular structural and functional abnormalities are present in cats with HCM and are associated with clinical severity.AnimalsEighty‐one client‐owned cats.MethodsRetrospective 2‐dimensional (2D) echocardiographic study. Right atrial diameter (RAD), RV free wall thickness (RVFWd), RV internal dimension (RVIDd), RV fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were measured in control cats (n = 26), cats with subclinical HCM (subclinical HCM; n = 31), and cats with HCM and congestive heart failure (HCM + CHF; n = 24).ResultsRight heart size (RAD, RVFWd, and RVIDd) and RV function (FAC and TAPSE) significantly (all P < .05) increased and decreased, respectively, in the HCM + CHF group compared with controls. In the subclinical HCM group, only RVFWd was significantly (P < .05) higher than in controls. Compared with reference intervals derived from controls, 29% of cats with HCM had increased RVFWd. Increased left ventricular free wall thickness, increased RVIDd and decreased TAPSE independently correlated with increased left atrial size. Cats with HCM and pleural effusion were significantly more likely to have increased RVFWd and had increased RAD and decreased TAPSE compared with cats without pleural effusion.Conclusions and Clinical ImportanceRight ventricular remodeling and dysfunction occur in some cats with HCM and may be associated with clinical severity. Our results support involvement of RV in the pathophysiology of HCM in some cats and support echocardiographic assessment of the RV in cats with HCM.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

Visser

Sloan

Stern

2017

Veterinary Internal Medicne

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“…Although the decrease in systemic vascular resistance may have played a role, the increase in cardiac index also serves to emphasize the importance of right ventricular unloading in heart failure patients and its potential favourable impact on diastolic ventricular interaction [12]. The relevance of this response is evident by the prognostic significance of right ventricular ejection fraction in heart failure patients [13]. This increase in cardiac index could be a marker of better short term prognosis [14].…”

Section: Discussionmentioning

confidence: 99%

The effects of intravenous sildenafil on hemodynamics and cardiac sympathetic activity in chronic human heart failure

Al‐Hesayen

Floras

Parker

2006

European J of Heart Fail

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Background: Erectile dysfunction is common in patients with chronic heart failure and sildenafil is an effective treatment option in this population. Sildenafil has been reported to increase sympathetic outflow in normal volunteers. To date, experience with sildenafil in patients with congestive heart failure is limited and the impact of phosphodiesterase-5 inhibition on sympathetic activity in this population has not been evaluated. Methods and results: 10 patients with heart failure (ejection fraction 23 T 3%) were studied. Generalized and cardiac sympathetic activity responses to an intravenous infusion of sildenafil were measured by the norepinephrine spillover method. In response to sildenafil, there was a significant reduction in mean pulmonary artery (À 26 T 5%, P < 0.01) and mean arterial pressures (À 8 T 1%, P < 0.01). These hemodynamic responses were accompanied by a 22 T 5% reduction in cardiac norepinephrine spillover ( P < 0.02) but no change in total body norepinephrine spillover. Conclusions: The acute administration of sildenafil is associated with a modest reduction in systemic arterial blood pressure and a more substantial reduction in pulmonary arterial pressure. These hemodynamic changes are observed in the absence of systemic sympathetic activation and are associated with a reduction in cardiac norepinephrine spillover in patients with chronic heart failure. These observations are relevant given the high prevalence of erectile dysfunction in this patient population.

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“…32 In patients with advanced HF-rEF, studies have shown that right ventricular (RV) function predicts survival. [33][34][35] Until recently there were few data published on RV function and survival in HFpEF, but Melenovsky et al 36 recently showed that RV dysfunction was present in a third of patients with HF-pEF. Those with RV dysfunction and HF-pEF had worse hemodynamics at RHC, and RV dysfunction was a strong predictor of mortality.…”

Section: Clinical Implications Of Ph In Hf-pefmentioning

confidence: 99%

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

et al. 2016

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Abstract:The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data.Keywords: pulmonary arterial hypertension, combined pre-and postcapillary pulmonary hypertension, heart failure with preserved ejection fraction, diastolic dysfunction. (Table 1) by a mean pulmonary arterial pressure (PAP) of ≥25 mmHg at right heart catheterization (RHC), with the most recent classification identifying 5 groups (Fig. 1): 2 group 1, pulmonary arterial hypertension (PAH), which can be idiopathic (IPAH) or associated with other conditions (most frequently systemic sclerosis and congenital heart disease); group 2, PH owing to left heart disease (PH-LHD); group 3, PH owing to lung disease (PH-Lung); group 4, chronic thromboembolic PH (CTEPH); and group 5, PH owing to unclear or multifactorial mechanisms. Accurate classification of disease is important in identifying the most appropriate form of therapy 3 and defining prognosis. 4 This requires a systematic approach to the evaluation of the breathless patient and an awareness of conditions associated with particular forms of PH. Pulmonary hypertension (PH) is definedThe most commonly encountered form of PH is related to left heart disease (LHD). 5,6 PH may be seen in heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HF-rEF), and its presence in HF-rEF is known to convey a poor prognosis. 7 HF-pEF accounts for approximately half of all new heart failure (HF) diagnoses. 8,9 While HF-pEF was initially believed to confer a better outcome than HF-rEF, the two conditions have equivalent morbidity and mortality. [10][11][12] The prevalence of PH-HF-pEF is unclear and varies with diagnostic criteria. Studies quote rates of between 53% and 83% (based on an echocardiographic systolic PAP [sPAP] > 35 mmHg or mean PAP > 25 mmHg at RHC). 13-15 A recent study 16 found that only 7% of heart failure (HF) patients had PH (but used an sPAP cutoff of ≥45 mmHg at echocardiography). PATHOPHYSIOLOGY OF PH-LHDPAH, PH-Lung, and CTEPH are precapillary in nature, caused by obstruction or destruction of the pulmonary arterial bed, whereas PH-LHD is thought to be primarily due to postcapillary abnormalities. 5 In patients with LHD, an increase in left ventricular (LV) and left atrial (LA) filling pressu...

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Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure

Abstract: In addition to the NYHA classification and to the percent of maximal predicted VO2, RVEF is an independent predictor of survival in patients with moderate CHF.

Cited by 589 publications

References 25 publications

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

The effects of intravenous sildenafil on hemodynamics and cardiac sympathetic activity in chronic human heart failure

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

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