title: Right ventricular systolic function for risk stratification in patients with stable left ventricular systolic dysfunction: comparison of radionuclide angiography to echoDoppler parameters.
abstract: OBJECTIVE
  Previous studies have demonstrated that the radionuclide right ventricular (RV) ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler peak systolic tricuspid annular velocity (STr) were independent predictors of cardiac survival in stable patients with left ventricular systolic dysfunction (LVSD). No study has compared the prognostic value of these three RV parameters. The aim of this study was to compare the prognostic value of RVEF, TAPSE, and STr in a large group of patients with LVSD.
  
  
  RESULTS
  We analysed 527 consecutive patients who underwent an extensive prognostic evaluation (clinical data, biological data, radionuclide angiography, echoDopplercardiography, cardiopulmonary exercise test). Tricuspid annular plane systolic excursion and STr were weakly correlated with RVEF (r = 0.20). During a follow-up period of 1268 days (802-1830), there were 121 cardiovascular deaths. Best cut-off values were 37%, 9.7 cm/s, and 18.5 mm for RVEF, STr, and TAPSE, respectively. Right ventricular ejection fraction was a powerful independent predictor of cardiac survival [relative risk (RR): 2.05 (1.29-3.26), P = 0.002]. Peak systolic tricuspid annular velocity added a modest prognostic information [RR: 1.56 (1.02-2.39), P = 0.04]. However, the combination of STr with RVEF was the most powerful predictor of cardiovascular death. Tricuspid annular plane systolic excursion was not an independent predictor of cardiac survival.
  
  
  CONCLUSIONS
  Right ventricular systolic function remains a powerful independent predictor of the clinical outcome. Even in the context of a complete echocardiographic assessment, radionuclide RVEF continues to be the most powerful RV systolic parameter for cardiac survival prediction. However, the determination of STr, in addition to RVEF, could improve risk stratification.
authors.affiliation: Service de Cardiologie, Pôle Cardio-Vasculaire et Pulmonaire, Hôpital Cardiologique, Boul Prof J Leclercq, Centre Hospitalier Régional et Universitaire de Lille, Lille, France. pdegroote@chru-lille.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: de Groote
authors.forename: Marie
authors.initials: M
authors.lastname: Fertin
authors.forename: Céline
authors.initials: C
authors.lastname: Goéminne
authors.forename: Grégory
authors.initials: G
authors.lastname: Petyt
authors.forename: Sandrine
authors.initials: S
authors.lastname: Peyrot
authors.forename: Claude
authors.initials: C
authors.lastname: Foucher-Hossein
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mouquet
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
mesh_terms: D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D011875:Radionuclide Angiography / Q000379:methods; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D014261:Tricuspid Valve / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*