Echocardiographic grading of right ventricular dysfunction improves risk stratification of patients with severe heart failure.

BACKGROUND

Right ventricular dysfunction (RVD) is a marker of adverse outcomes in heart failure (HF). We used a 5-point RVD score to describe three phenotypes (preserved RV function, RVD and RV failure) and investigated their relationhip with cardiac function and their contribution to risk stratification.

METHODS

Patients (n = 201) with HF, undergoing right heart catheterization and echocardiography were included. The RVD score comprised pulmonary hypertension, reduced tricuspid annular plane systolic excursion (TAPSE), RV enlargement, ≥ moderate tricuspid regurgitation and decreased vena cava inferior collapsibility. The endpoint was a composite of all-cause mortality or left ventricular (LV) assist device implantation.

RESULTS

Mean age was 52 ± 14 years, LV ejection fraction was 24 ± 8 %. Patients with RVD3-5 (n = 93) had, compared with RVD1-2 (n = 81) and RVD0 (n = 27), more deformed RV with higher RVdiameter/RVlenght ratio (P < 0.001) and higher RV end-diastolic pressure (P < 0.001). Among patients with RVD0, 77 % had compensated HF, while 65 % of RVD3-5 had overt HF. During 17 months of follow-up, 64 patients met the endpoint. There was an increase in adverse events from RVD0 to RVD1-2 and RVD3-5 (0, 25 and 47 %, P < 0.001). At univariable analysis, TAPSE, TAPSE/systolic pulmonary pressure and the RVD score were associated with the risk of adverse outcomes. After adjusting for clinical and echocardiographic characteristics, only the RVD score remained associated with the endpoint (HR 1.97, 95 % CI 1.08-3.70, P = 0.03).

CONCLUSIONS

Increments of the RVD score reflect worsening of RV and LV function and improve risk stratification of patients with severe HF.