Abstract 3568: Combined Prognostic Value of Tissue Doppler Right Ventricular Systolic and Diastolic Function Indices and Plasma B-Type Natriuretic Peptide in Patients With Advanced Heart Failure
Right ventricular (RV) dysfunction adversely affects prognosis in patients with chronic heart failure (HF) due to left ventricular (LV) dysfunction. However, little evidence exists regarding the prognostic role of RV systolic and diastolic function indices in combination with plasma b-type natriuretic peptide (BNP) in advanced HF.
Methods: One hundred and two consecutive hospitalized patients with advanced HF (NYHA class III–IV) due to LV systolic dysfunction (LV ejection fraction, LVEF <35%) and without atrial fibrillation, were studied by two-dimensional echocardiography, conventional Doppler and tissue Doppler (TDI) echocardiography of the LV and RV. Plasma levels of BNP were also measured. Patients were followed for 6 months for major cardiovascular events [cardiovascular death (CV) and HF-related hospitalization].
Results: During the follow-up, 13 patients (13%) died and 57 patients (56%) were hospitalized due to HF decompensation. By univariate analysis, female gender (p=0.013), dilated cardiomyopathy (p=0.005), NYHA class IV (p=0.005), digoxin treatment (p=0.007), BNP (p=0.016), and RV TDI systolic velocity (S, p=0.003) were associated with CV death, while NYHA class IV (p=0.008), BNP (p=0.016), transmitral Doppler to mitral annular TDI early diastolic velocity ratio (LV E/Em) (p=0.01) and the ratio of early to late RV diastolic TDI velocities (RV E/A, p< 0.0001) predicted HF hospitalization. In multivariate analysis, dilated cardiomyopathy (p=0.017), female gender (p=0.035) and RV S< 7.3cm/sec (0.018) were independent predictors of CV death, whereas RV E/A ≥0.68 (p=0.013) and BNP ≥762pg/ml (p=0.012) predicted HF hospitalization. In conclusion, TDI RV systolic and diastolic dysfunction combined with increased plasma BNP may additively predict adverse cardiac outcomes in advanced HF.