Stefano Ghio1, Marco Guazzi2, Angela Beatrice Scardovi3, Catherine Klersy4, Francesco Clemenza5, Erberto Carluccio6, Pier Luigi Temporelli7, Andrea Rossi8, Pompilio Faggiano9, Egidio Traversi10, Olga Vriz11, Frank Lloyd Dini12. 1. Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Piazza Golgi 1, 27100, Pavia, Italy. 2. Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, IRCCS, Policlinico San Donato University Hospital, Milano, Italy. 3. Cardiologia, Ospedale Santo Spirito, Roma, Italy. 4. Biometry & Statistics, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 5. Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy. 6. Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy. 7. Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy. 8. Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy. 9. Department of Cardiology, Spedali Civili Hospital and University of Brescia, Italy. 10. Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Montescano, Italy. 11. Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Italy. 12. Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
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 <140 ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40 mmHg 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.
AIMS: To evaluate whether the clinical and echocardiographic correlates and the prognostic significance of right ventricular (RV) dysfunction are different in heart failurepatients 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 <140 ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP >40 mmHg 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 failurepatients.
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