title: Impact of right ventricular dysfunction on the outcome of heart failure patients undergoing surgical ventricular reconstruction†.
abstract: OBJECTIVE
  The aim was to assess the impact of right ventricular dysfunction (RVD) on the outcome of heart failure (HF) patients undergoing surgical ventricular reconstruction (SVR).
  
  
  METHODS
  A total of 324 patients (65 ± 9 years) with previous myocardial infarction had an echocardiographic assessment of right ventricular (RV) function before and after SVR. RV function was assessed measuring the tricuspid annular plane systolic excursion (TAPSE) and RV dysfunction was defined by a TAPSE < 16 mm.
  
  
  RESULTS
  RV dysfunction was detected in 69 patients (Group A, mean age 64 ± 11 years), while 255 patients (Group B, mean age 65 ± 9 years) had a preserved RV function. Patients in Group A showed a higher New York Heart Association (NYHA) class (P = 0.01), larger left ventricular (LV) end-diastolic and end-systolic volumes (P = 0.01), a lower EF (P = 0.01), a higher percentage of moderate-to-severe mitral regurgitation (P = 0.01) and a higher systolic pulmonary artery pressure (PAPs; P = 0.01). Propensity score matching was applied in order to adjust for baseline differences. In the fully matched population, low-output syndrome (P = 0.01), inotropic support (P = 0.01) and intra-aortic balloon pump insertion (P = 0.03) were significantly more frequent in Group A compared with Group B. However, 30-day mortality was not significantly different between the two groups (P = 0.18). Kaplan-Meier 5- and 8-year survival rate (log-rank: P = 0.01) as well as freedom from cardiac events (log-rank: P = 0.02) were significantly lower in patients with RV dysfunction. At Cox regression analysis, preoperative RVD (P = 0.01) and NYHA class at admission >II (P = 0.02) resulted in independent predictor of late mortality.
  
  
  CONCLUSIONS
  RV dysfunction correlates with LV dysfunction and it is an important predictor of long-term outcome in HF patients undergoing SVR.
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Milan, Italy agaratti@tiscali.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Castelvecchio
authors.affiliation: Department of Cardiovascular Disease, L'Aquila University, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Heart Failure Unit, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandera
authors.affiliation: Heart Failure Unit, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.affiliation: Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality*
keywords: Heart failure; Right ventricular dysfunction; Surgical ventricular reconstruction; pulmonary hypertension