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J Am Coll Cardiol, 1998; 32:948-954
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure

Pascal de Groote, MDa, Alain Millaire, MD, PhDa, Claude Foucher-Hossein, MD*, Olivier Nugue, MDa, Xavier Marchandise, MD, PhD*, G.érard Ducloux, MDa and Jean-Marc Lablanche, MD, FACCa

a Service de Cardiologie C, Hôpital Cardiologique, Lille, France
* the Service Central de Médecine Nucléaire et Imagerie Fonctionnelle, Hôpital Roger Salengro, Lille, France

Manuscript received January 21, 1998; revised manuscript received May 26, 1998, accepted June 5, 1998.

Address for correspondence: Dr. Pascal de Groote, Service de Cardiologie C, Hôpital Cardiologique, CHRU, Boul Prof J Leclercq, 59037 Lille Cedex, France
pdegroote{at}chru-lille.fr

Objectives. We sought to study the relationship between survival and right ventricular ejection fraction (RVEF) in a subgroup of patients with moderate congestive heart failure (CHF).

Background. It has been demonstrated that RVEF is an independent predictor of survival in patients with advanced CHF.

Methods. Cardiopulmonary exercise testing and radionuclide angiography (to determine right and left ventricular ejection fraction) were prospectively performed in 205 consecutive patients with moderate CHF (140 patients in New York Heart Association [NYHA] class II, 65 in class III).

Results. Left ventricular ejection fraction was 29.3% ± 10.1%, RVEF was 37.5% ± 14.6% and peak oxygen consumption (VO2) was 16.2 ± 5.4 ml/min/kg (60.2% ± 19% of maximal predicted VO2). After a median follow-up period of 755 days, there were 44 cardiac-related deaths, 3 deaths from noncardiac causes and 15 transplantations of whom 2 were urgent; 1 patient was lost to follow-up. Multivariate analysis showed that three variables—NYHA classification, percent of maximal predicted VO2 and RVEF—were independent predictors of both survival and event-free cardiac survival. Left ventricular ejection fraction and peak VO2 normalized to body weight had no predictive value. The event-free survival rates from cardiovascular mortality and urgent transplantation at 1 year were 80%, 90% and 95% in patients with an RVEF <25%, with a RVEF ≥25% and <35% and with a RVEF ≥35%, respectively. At 2 years, survival rates were 59%, 77% and 93% in the same subgroups, respectively.

Conclusions. In addition to the NYHA classification and to the percent of maximal predicted VO2, RVEF is an independent predictor of survival in patients with moderate CHF.

Abbreviations and Acronyms
  CHF = congestive heart failure
  LVEF = left ventricular ejection fraction
  NYHA = New York Heart Association
  RVEF = right ventricular ejection fraction
  SPAP = systolic pulmonary artery pressure
  UNOS = United Network for Organ Sharing
  VO2 = oxygen consumption




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