Abstract 2960: Right Ventricular Function is an Independent Predictor of Mortality in CHF
Introduction Right ventricular (RV) dysfunction has been associated with increased mortality in small studies of advanced heart failure (HF) and myocardial infarction. We evaluated the long-term prognostic information from Tricuspid annular plane systolic excursion (TAPSE), a simple measure of RV ejection fraction, in a large consecutive population admitted for HF.
Methods A total of 911 patients admitted to hospital with HF, underwent trans-thoracic echocardiography including TAPSE performed as part of the baseline screening for the ECHOS trial (a placebo-controlled, randomized trial of a pre-synaptic dopaminergic agonist). TAPSE was measured by M-mode echocardiography of the lateral tricuspid annulus as the mean of measurements from 5 cardiac cycles. Left ventricular ejection fraction was estimated by wall motion score. Data are presented as medians (25 and 75 percentiles)
Results The 911 patients were followed for 3.0 (1.4–3.3) years. The median age was 74 (66 to 81) years, 60% were male, and 64% had a medical history of HF. TAPSE was 17.2 (13.2–21) mm and left ventricular ejection fraction 30 (19–39)%. TAPSE was divided into quartiles and lower values was associated with increased mortality at 1 year and at end of follow-up, log-rank p = 0.003 and p = 0.01, respectively. A multivariate Cox model (backward elimination) identified TAPSE as a significant predictor of mortality (hazard ratio (HR) = 0.74, 95% CI: 0.59 – 0.93 per doubling of TAPSE), independent of a prior medical history of HF (HR = 1.39, CI: 1.08–1.79), chronic obstructive pulmonary disease (HR = 2.40, CI: 1.13–1.86), or age (HR = 1.62, CI: 1.45–1.82 per 10 year increase). Other significant parameters were BMI, sex, or presence of valvular disease, renal failure, or diabetes. Left ventricular ejection fraction was not a significant co-variate in the final model.
Conclusion Decreased RV ejection fraction, as estimated by tricuspid annular plane systolic excursion, is significantly associated with long-term mortality in patients admitted for heart failure, and appears to be a strong predictor of mortality, independent of left ventricular ejection fraction. This simple non-invasive estimate of RV function provides improved risk stratification in patients with heart failure.