Prognostic Significance of an Early Echocardiographic Evaluation of Right Ventricular Dimension and Function in Acute Heart Failure

Alberto Palazzuoli, Gaetano Ruocco, Isabella Evangelista, Oreste De Vivo, Ranuccio Nuti, Stefano Ghio

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Sparse and contradictory data are available on the prognostic role of an early echocardiographic examination in patients with acute decompensated heart failure (ADHF). We planned a prospective study to illustrate which early echocardiographic parameter would be better related to prognosis in such patients. Methods: In a consecutive series of patients with ADHF with either reduced (n=209) or preserved (n=172) left ventricular ejection fraction (LVEF), a complete echocardiographic examination was performed within 12 hours of admission. The endpoint of the study was death or rehospitalization at 6 months from hospital discharge. Results: After 6 months from discharge, 73 died and 96 were rehospitalized due to cardiovascular causes. In multivariable analysis, a right ventricular end-diastolic diameter (RVEDD) >40 mm (P =.02), a tricuspid annular plane systolic excursion (TAPSE) <19 mm (P=.004), and an inferior vena cava diameter >22 mm (P =.02) were associated with 6-month events. LVEF and LV diastolic function were not predictive of events. Pulmonary artery systolic pressure (PASP) >45 mmHg and TAPSE/PASP <0.425 were associated with prognosis in univariate but not in multivariable analysis. Conversely, the TAPSE/RVEDD ratio (dichotomized at its median value of 0.461) was an independent predictor of outcome in multivariable analysis (P<.001). Conclusions: In patients hospitalized for ADHF, early echocardiographic identification of right ventricular dilatation and dysfunction predicts a poor outcome better than LV systolic and/or diastolic dysfunction.

Original languageEnglish
JournalJournal of Cardiac Failure
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Acute decompensated heart failure, right ventricular function
  • outcome, echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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