Right ventricular dysfunction and adverse outcome in patients with advanced heart failure.
BACKGROUND
In patients with heart failure (HF) from left ventricular systolic dysfunction, the presence of coexistent right ventricular (RV) dysfunction is associated with poor exercise capacity and reduced survival. We sought to determine whether a simple measure of RV function, the RV myocardial performance index (RV MPI), is associated with adverse outcome in a population of advanced heart failure patients selected to receive cardiac resynchronization therapy (CRT).


RESULTS
The RV MPI was measured on 77 consecutive preimplantation echocardiograms. The relationship between RV MPI and the end point of all-cause mortality, transplantation, or ventricular assist device placement was evaluated. The end point occurred in 28 patients (36%) during a median follow-up of 21 months. The median RV MPI was 0.73 (interquartile range 0.51-0.89). Worse RV function, as demonstrated by a higher RV MPI, was seen in those patients who reached the end point compared with those who did not (0.83 vs. 0.69, P = .004). The highest tercile of RV MPI was associated with a 3.3-fold increased risk of poor outcome (95% CI 1.3-8.5). Each 0.1 unit increase in RV MPI was associated with a 16% increased risk (95% CI 8-26). After adjusting for other echocardiographic variables, RV MPI remained significantly associated with the outcome.


CONCLUSIONS
In a population of advanced HF patients selected to receive CRT, RV dysfunction, as assessed by the RV MPI, is associated with adverse outcome. Wider use of this simple nongeometric parameter may help to identify patients for whom options for further intervention should be carefully evaluated.
Field
Michael E
ME
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Solomon
Scott D
SD
Lewis
Eldrin F
EF
Kramer
Daniel B
DB
Baughman
Kenneth L
KL
Stevenson
Lynne W
LW
Tedrow
Usha B
UB
D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications*