Comparison of four right ventricular systolic echocardiographic parameters to predict adverse outcomes in chronic heart failure.
OBJECTIVE
Heart failure (HF) has a poor prognosis. Several right ventricular (RV) echocardiographic parameters have been proposed as sensitive markers to detect patients at risk. Our objective was to compare the predictive value of four RV systolic echocardiographic parameters for outcomes in patients with HF.


RESULTS
One hundred and thirty-six patients with stable HF and a left ventricular ejection fraction <35% were assessed for the following: (i) RV fractional area (RVFA), (ii) tricuspid annular plane systolic excursion (TAPSE), (iii) integral of the systolic wave (ISW(tdi)), and (iv) peak systolic velocity (PSV(tdi)). ISW(tdi) and PSV(tdi) were measured using tissue Doppler imaging at the tricuspid annulus. The primary endpoint was death, urgent transplantation, urgent ventricular assist device implantation, or an acute HF episode. During a mean follow-up of 295 days, 33 patients reached the primary endpoint. The cut-off thresholds for RVFA, TAPSE, PSV(tdi), and ISW(tdi) defined using receiver-operating characteristic curves were 36.8%, 13.5 mm, 9.5 cm s(-1), and 1.75 cm, respectively. On Cox multivariate analysis, NYHA, log BNP, and only PSV(tdi) from the RV systolic parameters were found to be independent predictors of outcome.


CONCLUSIONS
PSV(tdi) is a strong independent predictor of outcome in HF at a threshold value of 9.5 cm s(-1) and appears to be superior to other RV systolic echocardiographic parameters.
Damy
Thibaud
T
Fédération de cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, 51 Avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France. thibaud.damy@gmail.com
Viallet
Caroline
C
Lairez
Olivier
O
Deswarte
Guillaume
G
Paulino
Alexandra
A
Maison
Patrick
P
Vermes
Emmanuelle
E
Gueret
Pascal
P
Adnot
Serge
S
Dubois-Randé
Jean-Luc
JL
Hittinger
Luc
L
D000465:Algorithms; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013599:Systole; D017211:Treatment Failure; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology