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Right ventricular dysfunction in patients with atrial fibrillation, chronic heart failure and electronic devices correlates with NYHA class but not with NT-proBNP and 6-minute walk test results.

Session HIT Poster session 3

Speaker Ewa Majos-Karwacka

Event : EuroEcho 2017

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Poster Session

Authors : E Majos (Warsaw,PL), A Kraska (Warsaw,PL), I Kowalik (Warsaw,PL), E Smolis-Bak (Warsaw,PL), H Szwed (Warsaw,PL), R Dabrowski (Warsaw,PL)

E Majos1 , A Kraska1 , I Kowalik1 , E Smolis-Bak1 , H Szwed1 , R Dabrowski1 , 1Institute of Cardiology - Warsaw - Poland ,

European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii249

Backround. Transthoracic echocardiography (TTE) is a standard diagnostic method in chronic heart failure with reduced ejection fraction (HFrEF). The right ventricular (RV) function is not fully established in HFrEF patients with permanent atrial fibrillation (PAF) and cardiac implantable electronic devices (CIED).

Purpose. The aim of the study was evaluation of standard parameters used for assessment of the RV  in TTE: tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular systolic velocity (s’) and right ventricular fractional area change (RVFAC) and their potential correlation with NYHA functional class, NT-proBNP levels and 6-minute walk test (6-MWT) results in patients with HFrEF of ischemic origin, PAF, RV pacing and cardiac resynchronisation therapy (CRT).

Methods. Patients with PAF, HFrEF (NYHA II,III; LVEF =40%) and CIED, were enrolled in the study. Four groups were analysed: with sinus rhythm (control, group G1), with PAF (group G2),  PAF and CRT for at least one year (group G3) and PAF and RV pacing (VVI mode) for at least 1 year (group G4). All the patients had TTE to assess the RV function: TAPSE, tricuspid lateral annular systolic velocity (s’) and RVFAC. 6-MWT and NT-proBNP were evaluated in all the patients. Spearman correlation coefficients were used to analyse data.

Results. Total of 126 patients were enrolled in the study: n=32 in group G1, n=28 in group G2, n=25 in group G3 and n=41 in group G4. The mean age of the patients was 70.5-74.5 years and mean heart rate: 75.5-79 per minute, with no significant differences between groups. Mean time of PAF duration was  3 years (G2),  5 years (G3),  5 years (G4). The mean LVEF was: 32.8% (G1), 30.4(G2), 27.8 (G3) and 26,4(G4). The mean RV diastolic area was: 21.0cm2(G1), 26.6cm2(G2), 23.5cm2 (G3), 24.5cm2 (G4), G1 vs. G2: p=0,0181. RV function parameters showed moderately depressed RV function in all studied groups. TAPSE and s‘ values correlated with functional NYHA class in all enrolled patients, respectively: TAPSE: 2.09±0.57cm, NYHA II; 1.78±0.47, NYHA III; p= 0.0038 and s’: 10.8±3.1cm/s, NYHA II; 9.2±2.4cm/s, NYHA III, p= 0.0323. That was not observed for RVFAC (38.6±12.6% in NYHA II; 35.6±12,2% in NYHA III; p=0.2133). Parameters of RV function did not correlate with NT-pro BNP levels and with 6-WMT results. Correlations between the RV function parameters and NT-proBNP and 6-MWT within the groups were not found.

Conclusions. HFrEF of ischemic origin in patients with permanent AF and CIED is a complex condition.  RV function impairment correlated with NYHA functional class, but not with NT-proBNP and 6MWT results.

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