Right ventricular function and prognosis in stable heart failure patients.
BACKGROUND
Right ventricular ejection fraction (RVEF) is a mortality predictor in heart failure (HF) patients. There are controversial results regarding the influence of RVEF on other important prognostic variables. The purpose of this study was to investigate the effect of RVEF on exercise parameters obtained during cardiopulmonary exercise testing (CPET), creatinine and B-type natriuretic peptide (BNP) levels, and a composite outcome of death, heart transplantation, or ventricular assist device implantation in ambulatory HF patients.


RESULTS
This retrospective cohort study included 246 ambulatory HF patients with CPET and RVEF evaluated with the use of first-pass radionuclide angiography. We analyzed the impact of RVEF on other prognostic factors with the use of multivariable linear regression. The mean age was 49 ± 12 years. The mean peak VO2 was 16.4 ± 5.7 mL kg(-1) min(-1), mean peak VE/VCO2 34.1 ± 9.1, mean creatinine 1.17 ± 0.40 mg/dL, and median BNP 158 pg/mL (interquartile range 374 pg/mL). The mean left ventricular ejection fraction was 35 ± 12% and the mean RVEF 38 ± 10%. For every 10% decrease in RVEF, peak VO2 decreased 0.97 mL kg(-1) min(-1) (P < .05), creatinine increased 0.12 mg/dL (P < .01), and log BNP increased 0.26 (P < .05).


CONCLUSIONS
We found an independent association between RVEF and prognostic markers in HF patients. Worsening RV function may exert its negative effect on prognosis through increasing congestion (elevated BNP), affecting renal blood flow (increased creatinine) and limiting left ventricular preload, thereby reducing exercise tolerance.
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: danimur70@hotmail.com.
Daniel
D
Murninkas
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Ana C
AC
Alba
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Diego
D
Delgado
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Michael
M
McDonald
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Filio
F
Billia
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Wai S
WS
Chan
Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Heather J
HJ
Ross
D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016278:Ventricular Function, Right / Q000502:physiology*
BNP; VE/VCO(2); VO(2max); creatinine