Right ventricular systolic echocardiographic parameters in chronic systolic heart failure and prognosis

BackgroundRight ventricular (RV) dysfunction is associated with poor prognosis in patients with heart failure (HF). Several RV echocardiographic parameters have been proposed as sensitive markers to detect patients at risk.ObjectiveThe aim is to compare the predictive value of several RV systolic echocardiographic parameters for adverse outcome in patients with chronic systolic HF.MethodsWe assessed 117 patients with chronic systolic HF and left ventricular ejection fraction (LVEF) <40% for the following: (i) RV fractional area change (RVFAC), (ii) tricuspid annular plane systolic excursion (TAPSE), (iii) integral of the systolic wave (ISWtdi), and (iv) peak systolic velocity (Satdi). ISWtdi and Satdi were measured using tissue Doppler imaging at the tricuspid annulus. The primary endpoint was death, urgent transplantation, or acute HF episode requiring hospital admission. The follow-up extended for one year.ResultsFifty-two patients reached the primary endpoint. The cut-off thresholds for RVFAC, TAPSE, Satdi, and ISWtdi defined using receiver-operating characteristic curves were 30%, 15.5 mm, 10.0 cm/s, and 2.4 cm, respectively. The area under the curve and the 95% confidence interval for RVFAC, TAPSE, Satdi, and ISWtdi were 0.71(0.65–0.85), 0.66(0.55–0.76), 0.85(0.70–0.96), and 0.75(0.64–0.86), respectively. NYHA > 2, and Satdi were found to be independent predictors of adverse outcome.ConclusionSatdi is an independent predictor of adverse outcome in HF at a threshold value of 10.0 cm/s and appears to be superior to other RV systolic echocardiographic parameters.