title: Prognostic significance of right ventricular dimension on acute decompensation in chronic left-sided heart failure.
abstract: Right ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent long-term outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≥ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters.
authors.affiliation: Department of Cardio-Angiology, Kitasato University School of Medicine.
authors.forename: Emi
authors.initials: E
authors.lastname: Maekawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Mizutani
authors.forename: Hisahito
authors.initials: H
authors.lastname: Shinagawa
authors.forename: Toshimi
authors.initials: T
authors.lastname: Koitabashi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takeuchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Tokita
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Inoue
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000473:pathology*