CLINICAL STUDY: HEART FAILURE
Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure
Stefano Ghio, MD, FESC*,
Antonello Gavazzi, MD, FESC*,
Carlo Campana, MD*,
Corinna Inserra, MD*,
Catherine Klersy, MD ,
Roberta Sebastiani, MD*,
Eloisa Arbustini, MD ,
Franco Recusani, MD* and
Luigi Tavazzi, MD, FESC, FACC*
* Dipartimento di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
Direzione Scientifica, IRCCS Policlinico S. Matteo, Pavia, Italy
Istituto di Anatomia Patologica, IRCCS Policlinico S. Matteo, Pavia, Italy
Manuscript received April 10, 2000;
revised manuscript received August 3, 2000,
accepted September 20, 2000.
Reprint requests and correspondence: Dr. Stefano Ghio, Dipartimento di Cardiologia, Policlinico S. Matteo, Piazza Golgi 1, 27100 Pavia, Italy
s.ghio{at}smatteo.pv.it
OBJECTIVES
We sought a better understanding of the coupling between right ventricular ejection fraction (RVEF) and pulmonary artery pressure (PAP), as it might improve the accuracy of the prognostic stratification of patients with heart failure.
BACKGROUND
Despite the long-standing view that systolic function of the right ventricle (RV) is almost exclusively dependent on the afterload that this cardiac chamber must confront, recent studies claim that RV function is an independent prognostic factor in patients with chronic heart failure.
METHODS
Right heart catheterization was performed in 377 consecutive patients with heart failure.
RESULTS
During a median follow-up period of 17 ± 9 months, 105 patients died and 35 underwent urgent heart transplantation. Pulmonary artery pressure and thermodilution-derived RVEF were inversely related (r = 0.66, p < 0.001). However, on Cox multivariate survival analysis, no interaction between such variables was found, and both turned out to be independent prognostic predictors (p < 0.001). It was found that RVEF was preserved in some patients with pulmonary hypertension, and that the prognosis of these patients was similar to that of the patients with normal PAP. In contrast, when PAP was normal, reduced RV function did not carry an additional risk.
CONCLUSIONS
These observations emphasize the necessity of combining the right heart hemodynamic variables with a functional evaluation of the RV when trying to define the individual risk of patients with heart failure.
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Abbreviations and Acronyms
| | LV | = left ventricle or ventricular | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | PAP | = pulmonary artery pressure | | RV | = right ventricle or ventricular | | RVEF | = right ventricular ejection fraction |
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