Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure.
BACKGROUND
The prognostic importance of right ventricular (RV) dysfunction in heart failure (HF) has been suggested in patients with severe systolic heart failure. Tricuspid annular plane systolic excursion (TAPSE) is a simple echocardiographic measure of RV ejection fraction, but may be affected by co-existing chronic obstructive pulmonary disease (COPD).


OBJECTIVE
To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF.


RESULTS
Eight hundred and seventeen patients screened for participation in a large clinical trial by trans-thoracic echocardiography, including measurement of TAPSE, were followed for a median of 4.1 years (maximum 5.5 years). Decreased TAPSE as well as presence of COPD were independently associated with adverse short- and long-term survival, hazard ratio was 0.74 (p=0.004) for every doubling of TAPSE; and 2.4 (p<0.0001) for the presence of COPD.


CONCLUSIONS
Decreased RV systolic function as estimated by TAPSE is associated with increased mortality in patients admitted for HF, and is independent of other risk factors in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function.
Kjaergaard
Jesper
J
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark. jesper.kjaergaard@rh.dk <jesper.kjaergaard@rh.dk>
Akkan
Dilek
D
Iversen
Kasper Karmark
KK
Køber
Lars
L
Torp-Pedersen
Christian
C
Hassager
Christian
C
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015897:Comorbidity; D018491:Dopamine Agonists / Q000627:therapeutic use; D004452:Echocardiography; D004952:Esters / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality*
D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D018491:Dopamine Agonists; D004952:Esters; D013764:Tetrahydronaphthalenes; C457559:nolomirole