Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction

Stefano Ghio, Marco Guazzi, Angela Beatrice Scardovi, Catherine Klersy, Francesco Clemenza, Erberto Carluccio, Pier Luigi Temporelli, Andrea Rossi, Pompilio Faggiano, Egidio Traversi, Olga Vriz, Frank Lloyd Dini

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Abstract

Aims: 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. Methods and results: 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 <140ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40mmHg 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. Conclusions: 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.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusAccepted/In press - 2016

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Right Ventricular Dysfunction
Heart Failure
Stroke Volume
Cardiomyopathies
Heart Diseases

Keywords

  • Echocardiography
  • Heart failure
  • Pulmonary hypertension
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction. / Ghio, Stefano; Guazzi, Marco; Scardovi, Angela Beatrice; Klersy, Catherine; Clemenza, Francesco; Carluccio, Erberto; Temporelli, Pier Luigi; Rossi, Andrea; Faggiano, Pompilio; Traversi, Egidio; Vriz, Olga; Dini, Frank Lloyd.

In: European Journal of Heart Failure, 2016.

Research output: Contribution to journalArticle

Ghio, Stefano ; Guazzi, Marco ; Scardovi, Angela Beatrice ; Klersy, Catherine ; Clemenza, Francesco ; Carluccio, Erberto ; Temporelli, Pier Luigi ; Rossi, Andrea ; Faggiano, Pompilio ; Traversi, Egidio ; Vriz, Olga ; Dini, Frank Lloyd. / Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction. In: European Journal of Heart Failure. 2016.
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AU - Ghio, Stefano

AU - Guazzi, Marco

AU - Scardovi, Angela Beatrice

AU - Klersy, Catherine

AU - Clemenza, Francesco

AU - Carluccio, Erberto

AU - Temporelli, Pier Luigi

AU - Rossi, Andrea

AU - Faggiano, Pompilio

AU - Traversi, Egidio

AU - Vriz, Olga

AU - Dini, Frank Lloyd

PY - 2016

Y1 - 2016

N2 - Aims: 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. Methods and results: 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 <140ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40mmHg 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. Conclusions: 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.

AB - Aims: 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. Methods and results: 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 <140ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40mmHg 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. Conclusions: 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.

KW - Echocardiography

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KW - Pulmonary hypertension

KW - Right ventricle

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