title: Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure.
abstract: BACKGROUND
  Studies of the effect of right ventricular ejection fraction (RVEF) on outcomes in heart failure (HF) are limited by small sample size and short follow-up.
  
  
  RESULTS
  We examined the effect of baseline RVEF on outcomes in 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with HF and left ventricular ejection fraction <or=35% during 24 months of mean follow-up. RVEF, estimated by gated-equilibrium radionuclide ventriculography, was used to categorize patients into 4 RVEF groups: >or=40% (n=733), 30% to 39% (n=531), 20% to 29% (n=473), and <20% (n=271). Unadjusted rates for all-cause mortality in patients with RVEF >or=40%, 30% to 39%, 20% to 29%, and <20% were 27%, 32%, 35%, and 47%, respectively. When compared with patients with RVEF >or=40%, unadjusted hazard ratios and 95% confidence intervals for all-cause mortality for those with RVEF 30% to 39%, 20% to 29%, and <20% were 1.19 (0.97 to 1.46; P=0.087), 1.45 (1.17 to 1.78; P=0.001), and 1.98 (1.59 to 2.47; P<0.0001), respectively. Respective multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause mortality associated with RVEF 30% to 39%, 20% to 29%, and <20% were 1.07 (0.87 to 1.32; P=0.518), 1.12 (0.89 to 1.40; P=0.328), and 1.32 (1.02 to 1.71; P=0.034), respectively. Adjusted hazard ratios (95% confidence intervals) for other outcomes associated with RVEF <20% (compared with >or=40%) were as follows: cardiovascular mortality, 1.33 (1.01 to 1.76; P=0.041); HF mortality, 1.61 (1.03 to 2.52; P=0.037); sudden cardiac death, 1.29 (0.87 to 1.91; P=0.212); all-cause hospitalization, 1.21 (1.00 to 1.47; P=0.056); and HF hospitalization, 1.39 (1.10 to 1.77; P=0.007).
  
  
  CONCLUSIONS
  Baseline RVEF <20% is a significant independent predictor of mortality and HF hospitalization in systolic HF.
authors.affiliation: Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Meyer
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Perry
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell'Italia
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome