title: Right ventricular dysfunction affects survival after surgical left ventricular restoration.
abstract: Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function.
  
  
  
  A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed.
  
  
  
  Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P < .01), tricuspid annular plane systolic excursion (hazard ratio, 0.80; 95% confidence interval, 0.66-0.96; P = .02), and right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P < .01) were independently associated with 30-day mortality, after adjusting for left ventricular ejection fraction and aortic crossclamping time. Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P < .01 per additional impaired parameter).
  
  
  
  Baseline right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left ventricular restoration.
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Lotte E
authors.initials: LE
authors.lastname: Couperus
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Meindert
authors.initials: M
authors.lastname: Palmen
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Marieke E
authors.initials: ME
authors.lastname: van Vessem
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Jerry
authors.initials: J
authors.lastname: Braun
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands; Mathematical Institute, Leiden University, Leiden, The Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Laurens F
authors.initials: LF
authors.lastname: Tops
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Harriëtte F
authors.initials: HF
authors.lastname: Verwey
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: s.l.m.a.beeres@lumc.nl.
authors.forename: Saskia L M A
authors.initials: SL
authors.lastname: Beeres
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: heart failure; right ventricular function; surgical left ventricular restoration