Abstract 18304: Prognostic Value of Right Ventriclular EchoDoppler Parameters in Patients With Left Ventricular Systolic Dysfunction: Comparison to Radionuclide Right Ventricular Ejection Fraction
Background: In patients with reduced left ventricular ejection fraction (LVEF), right ventricle (RV) systolic parameters are powerful predictors of survival.
Aim of the study: To compare the prognostic value of radionuclide RV ejection fraction (RVEF), of Tricuspid Annular Plane Systolic Excursion (TAPSE) and of Tissue Doppler Imaging of the peak systolic tricuspid annular velocity (STr) in a large group of stable patients with reduced LVEF.
Results: We studied 527 consecutive patients receiving maximal tolerated doses of renin inhibitors (98%) and betablockers (93%). Mean age was 56±13 years, 36% were in NYHA class III, 51% had ischemic cardiopathy. LVEF was 34±9%, median BNP was 135 pg/ml [35–328], RVEF 42±11%, TAPSE 20.3±6 mm, STr 10.4±2.7 cm/s. During a median follow-up period of 907 days, there were 98 cardiac related deaths. TAPSE and STr were correlated (r=0.56) and were entered separately in multivariate analyses. Independent predictors of cardiac survival were LVEF (p<0.001), BNP (p=0.002), NYHA class (p=0.004) and RVEF (p=0.03). Prognostic information of TAPSE and STr was similar (ROC curves, bivariate and multivariate analyses) and was less powerful than RVEF. However, combination of RVEF and RV Echo parameters improved risk stratification. Figure shows survival curves according to RVEF and Echo parameters. In multivariate analysis, combination of RV parameters was an independent predictor of cardiac survival (p=0.001). Other independent parameters in this model were LVEF (p=0.002), BNP (p=0.005) and NYHA class (p=0.01).
Conclusions: RVEF remained the most powerful RV parameter to predict cardiac survival in stable patients with reduced LVEF. However, TAPSE and STr, used in combination with RVEF, could help us for the risk stratification of these patients.
- © 2010 by American Heart Association, Inc.