Which parameter of right ventricular function predicts outcome in acute heart failure

RV systolic dysfunction is being recognised as significant prognostic marker of poor outcome in acute heart failure. We aimed to characterise the predictive capacity of RV systolic function on long term outcomes in those hospitalised in AHF.

418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bed-side echocardiography within 24 hours of recruitment. 8 parameters of RV systolic function were assessed in predicting 2-year mortality by identifying the sensitivity and specificity associated with the maximum Youden Index. These cut-offs were used as binary determinants of outcome in unadjusted Kaplan-Meier analysis.

7/8 binary assessments of RV systolic dysfunction were significantly predictive of 2 year outcome, including the tricuspid annulus systolic plane excursion (TAPSE) ≤1.6cm, RV fractional area change (RVFAC) ≤38.2%, peak systolic and end systolic RV inferior wall global longitudinal strain of >−18.6% and >−18%, inferior free wall average strain rate >−1.8 s^–1, a 2D ellipsoid model of RVEF <46.9% and the ratio of the TAPSE to systolic pulmonary artery pressure <0.0268 cm/mmHg (all p<0.02). Crude hazard ratios ranged from 1.50–2.13. Only the RV tissue doppler imaging S wave velocity ≤0.09m/s could not delineate those at risk of poor outcome (p=0.17).

A constellation of RV systolic assessment could effectively delineate those at risk of poor outcome following hospitalisation for AHF. The cut-offs identified were broadly similar to those from the ESC guidelines on RV chamber assessment. Only the S wave velocity from tissue doppler imaging was not predictive. This may be due to more angle dependency in measurements alongside the impact of loading conditions in acute heart failure. RV dysfunction should remain a serious focus of attention from acute physicians and echosonographers.

Type of funding sources: Private company. Main funding source(s): Abbott