title: Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure.
abstract: The purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure.
  
  
  
  A total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled. Fifty-nine patients met the primary composite endpoint of cardiac death, urgent heart transplantation, and urgent mechanical circulatory support implantation at 90 days. Pulmonary hypertension failed to predict events, while patients with a low transtricuspid systolic gradient (TR gradient <20 mmHg) showed a worse outcome [hazard ratio (HR) 2.37, 95% confidence interval (CI) 1.12-5.00, P = 0.02]. RV dysfunction [tricuspid annular plane systolic excursion (TAPSE) ≤14 mm] in the presence of a low TR gradient identified patients at higher risk of events (HR 2.97, 95% CI 1.19-7.41, P = 0.02). Multivariate analysis showed as best predictors of outcome low RV contraction pressure index (RVCPI), defined as TAPSE × TR gradient, and high estimated right atrial pressure (eRAP). Adding RVCPI (<400 mm*mmHg) and eRAP (≥20 mmHg) to conventional clinical (ADHERE risk tree and NT-proBNP) and echocardiographic risk evaluation resulted in an increase in net reclassification improvement of +19.1% and +20.1%, respectively (P = 0.01) and in c-statistic from 0.59 to 0.73 (P < 0.01).
  
  
  
  In acute decompensation of advanced CHF, pulmonary hypertension failed to predict events. The in-hospital and short-term prognosis can be better predicted by eRAP and RVCPI.
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Frea
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pidello
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Virginia
authors.initials: V
authors.lastname: Bovolo
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Iacovino
authors.affiliation: Division of Cardiology, Ospedale Civico of Chivasso, Torino, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Franco
authors.affiliation: Division of Cardiology, Ospedale Civico of Chivasso, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pinneri
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Galluzzo
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visconti
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peirone
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Morello
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Bergerone
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002908:Chronic Disease; D004452:Echocardiography; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; Advanced chronic heart failure; Echocardiography; Pulmonary pressure; Right atrial pressure; Right ventricle