Abstract 12055: Impaired Right Ventricular Function Affects Survival After Surgical Left Ventricular Reconstruction
Introduction: The determinants of survival after surgical left ventricular reconstruction (SVR) in ischemic heart failure remain not fully elucidated. Several left ventricular (LV) parameters have been associated with prognosis. The role of right ventricular (RV) function, however, remains to be determined.
Hypothesis: Impaired preoperative RV function is associated with worse outcome in patients undergoing SVR.
Methods: Consecutive patients (130 patients; age 62±10 years; 79% male; LV ejection fraction [LVEF] 27±7%; urgent surgery in 22%) underwent SVR between 2006 and 2012. Biventricular function was assessed by echocardiography before surgery. Parameters of impaired RV function were RV fractional area change (RVFAC) <35%, tricuspid annular plane systolic excursion (TAPSE) <16mm and RV longitudinal peak systolic strain (RV LPSS) ≥-19%. The independent association between these RV functional parameters and mortality was assessed in several non-nested multivariate analyses. Furthermore, the additive effect of multiple impaired RV parameters on mortality was assessed.
Results: Survival 30 days after SVR was 89%. Impaired RVFAC (HR 3.59, 95%CI 1.21-10.68, p=0.02), TAPSE (HR 2.96, 95%CI 1.05-8.35, p=0.04) and RV LPPS (HR 3.78, 95%CI 1.11-12.85, p=0.03) were independently associated with 30 day mortality, after adjusting for LVEF, the need for urgent surgery and surgery time. Moreover, a higher number of impaired RV parameters per patient was independently associated with increased mortality (HR 5.57, 95%CI 0.94-32.85, p=0.06 for 1 impaired parameter; HR 6.90, 95%CI 1.20-39.76, p=0.03 for 2 impaired parameters; HR 21.27, 95%CI 3.11-145.56, p<0.01 for 3 impaired parameters). Survival curves for impaired versus normal RVFAC, TAPSE and RV LPSS respectively and for multiple impaired parameters are presented in the figure.
Conclusion: Impaired pre-operative RV function is associated with increased 30 day mortality in patients undergoing SVR.
Author Disclosures: L.E. Couperus: None. V. Delgado: Speakers Bureau; Modest; Abbott Vascular. M. Palmen: None. L.F. Tops: None. M.E. Van Vessem: None. H.F. Verwey: None. R.J. Klautz: None. M.J. Schalij: None. S.L. Beeres: None.
- © 2015 by American Heart Association, Inc.