title: Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction.
abstract: To evaluate whether the clinical and echocardiographic correlates and the prognostic significance of right ventricular (RV) dysfunction are different in heart failure patients with reduced (HFrEF), mid-range (HFmrEF), or preserved (HFpEF) left ventricular ejection fraction.
  
  
  
  The study included 1663 patients with heart failure caused by ischaemic or hypertensive heart disease or by idiopathic cardiomyopathy. Left ventricular ejection fraction was <40% in 1123 patients (HFrEF), 40-49% in 156 patients (HFmrEF) and ≥50% in 384 patients (HFpEF). Imaging of the right ventricle was performed by echocardiography; RV function was defined on the basis of tricuspid annular plane systolic excursion (TAPSE) and its normalization for pulmonary artery systolic pressure (PASP). All-cause mortality was the endpoint of survival analysis. Non-sinus rhythm, high heart rate, ischaemic aetiology and E-wave deceleration time <140 ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40 mmHg was by far the strongest correlate of a reduced TAPSE in HFpEF and HFmrEF patients (interaction analysis, P = 0.0011). TAPSE/PASP proved to be a powerful predictor of prognosis in all patients.
  
  
  
  The correlates of RV dysfunction differ in HFrEF compared with HFpEF and HFmrEF patients. Regardless of the extent of LV dysfunction, the TAPSE/PASP ratio is a powerful independent predictor of prognosis in all heart failure patients.
authors.affiliation: Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Piazza Golgi 1, 27100, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.affiliation: Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, IRCCS, Policlinico San Donato University Hospital, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.affiliation: Cardiologia, Ospedale Santo Spirito, Roma, Italy.
authors.forename: Angela Beatrice
authors.initials: AB
authors.lastname: Scardovi
authors.affiliation: Biometry & Statistics, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.affiliation: Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
authors.forename: Erberto
authors.initials: E
authors.lastname: Carluccio
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
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: Department of Cardiology, Spedali Civili Hospital and University of Brescia, Italy.
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Montescano, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Traversi
authors.affiliation: Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Echocardiography; Heart failure; Pulmonary hypertension; Right ventricle