title: Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction.
abstract: BACKGROUND
  Recent studies suggest the significance of right ventricular (RV) function in the outcome in patients with left ventricular dysfunction (LVSD); however, global assessment of RV remains to be determined by echocardiogram because of its complex geometry. This study aimed to validate RV outflow tract fractional shortening (RVOT-FS) in the evaluation of RV function and its prognostic value in patients with LVSD.
  
  
  METHODS
  This study included eighty-one patients (62 ± 17 years, mean ± SD, male 79%) with reduced LV ejection fraction (LVEF) (≤40%). Two-dimensional echocardiogram of the parasternal short axis view was obtained at the level of the aortic root, and RVOT-FS was calculated as the ratio of end-diastole minus end-systole dimension to end-diastole dimension.
  
  
  RESULTS
  RVOT-FS ranged from 0.04 to 0.8 (0.3 ± 0.2, mean ± SD), and correlated with LVEF (r = 0.33, p = 0.0028), RV fractional area change (r = 0.37, p = 0.0008) and brain natriuretic peptide level (r = -0.38, p = 0.0005). In Cox multivariate regression analysis, RVOT-FS [hazard ratio (HR) 0.028, 95% confidence interval (CI): 0.002-0.397]; p = 0.008] and New York Heart Association functional class III-IV [HR 2.233, 95% CI: 1.048-4.761]; p = 0.037] were independent factors to predict the events. During a median follow-up period of 319 days (1 to 1862 days), patients with RVOT-FS ≥ 0.2 showed a higher event-free rate than those < 0.2 by Kaplan-Meier analysis (log-rank test, p = 0.0016).
  
  
  CONCLUSIONS
  Our data suggest that RVOT-FS is a simple parameter reflecting the severity of both ventricular function in patients with LVSD. In addition, RVOT-FS might be useful to predict adverse outcomes in such a patient population.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tsuruda
authors.forename: Yuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Onitsuka
authors.forename: Kuniko
authors.initials: K
authors.lastname: Furukawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ideguchi
authors.forename: Junji
authors.initials: J
authors.lastname: Kawagoe
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Johji
authors.initials: J
authors.lastname: Kato
authors.forename: Makoto
authors.initials: M
authors.lastname: Takenaga
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain