title: Right ventricular recovery during follow-up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction.
abstract: A compromised tricuspid annular plane systolic excursion (TAPSE) is associated with worse survival in patients with chronic heart failure with reduced ejection fraction (HFrEF). However, it is not known whether a reversible abnormal TAPSE at follow-up predicts survival. Our aim was to evaluate whether a reversible abnormal TAPSE is associated with a better survival in patients with chronic HFrEF.
  
  
  
  A complete echocardiography was performed in 706 patients with chronic HFrEF (LVEF ≤45%) at baseline and after 6 ± 3 months. Right ventricular (RV) systolic function was evaluated using TAPSE. The study endpoint was all-cause mortality. At baseline, TAPSE was severely reduced (≤14 mm) in 89 (13%) patients, and slightly reduced (>14 but <18 mm) in 157 (22%) patients. During a median follow-up of 40 months, 152 patients reached the endpoint. The event rate (per 100 patients/year) was lower in patients with persistently normal TAPSE (≥18 mm, n = 393) [3.3%, 95% confidence interval (CI) 2.5-4.3], and in those with reversible TAPSE (n = 120) (4.6%, 95% CI 3.1-7.0), compared with patients with worsening TAPSE (n = 90) (11.9%, 95% CI 8.7-16.3), and those with persistently reduced TAPSE (n = 103) (12.6%, 95% CI 9.3-17.1; log-rank 69.4, P < 0.0001). A reversible abnormal TAPSE was associated with improved survival at multivariable Cox regression analysis (hazard ratio 0.48, 95% CI 0.29-0.79, P = 0.004).
  
  
  
  Patients with chronic HFrEF who have abnormal TAPSE at baseline but reverse their dysfunction during follow-up have better survival than patients with either worsened TAPSE or persistently abnormal TAPSE, and similar to that of patients with persistently normal TAPSE.
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Erberto
authors.initials: E
authors.lastname: Carluccio
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Anca
authors.initials: A
authors.lastname: Simioniuc
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Biagioli
authors.affiliation: Department of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Gian Giacomo
authors.initials: GG
authors.lastname: Galeotti
authors.affiliation: Cardiac, Thoracic and Vascular Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa, Italy.
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.affiliation: Cardiac, Thoracic and Vascular Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Scelsi
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Giulia Elena
authors.initials: GE
authors.lastname: Mandoli
authors.affiliation: Cardiac, Thoracic and Vascular Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
authors.forename: Antonia
authors.initials: A
authors.lastname: Cannito
authors.affiliation: Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
authors.affiliation: Cardiac, Thoracic and Vascular Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
mesh_terms: D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D013318:Stroke Volume; D015996:Survival Rate; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016278:Ventricular Function, Right
keywords: Echocardiography; Heart failure; Prognosis; Right ventricular function