PROGNOSTIC-SIGNIFICANCE OF ECHOCARDIOGRAPHICALLY ESTIMATED RIGHT-VENTRICULAR SHORTENING IN ADVANCED HEART-FAILURE

Little is known about the association of echocardiographic estimates o f right ventricular (RV) function with survival, in relation to hemody namic and exercise-derived predictors of outcome in congestive heart f ailure. We prospectively studied 40 patients (age 55 +/- 10 years, in New York Heart Association functional class III [70%] and IV [30%]), w ith left ventricular (LV) ejection fraction <30%. At enrollment, all p atients underwent echocardiographic evaluation of LV dimensions and fu nction. RV shortening was measured as the difference of the end-diasto lic distance - the end-systolic: distance between the tricuspid annulu s and the RV apex. Thirty-five patients (88%) were able to perform a m aximal symptom-limited exercise test. Peak oxygen consumption (peak (V ) over dotO(2)) and percent peak age- and gender-adjusted predicted ox ygen consumption (%peak (V) over dotO(2)) were calculated. Of 40 patie nts, 10 died during a mean follow-up period of 14 +/- 10 months. On un ivariate analysis, nonsurvivors had lower RV shortening (p = 0.0001), higher pulmonary artery wedge pressure (p = 0.009), higher pulmonary v ascular resistance (p = 0.02), and lower mean aortic pressure (p = 0.0 5). Cox proportional-hazards model revealed that the only independent associate of survival was RV shortening (p 0.0005), with a trend towar d significance for mean aortic pressure (p = 0.08). The best cutoff po int of RV shortening identified by the receiver-operating curve was 1. 25 cm. This value had a sensitivity of 90%, specificity of 80%, and ov erall predictive accuracy of 83% to distinguish survivors from nonsurv ivors, In patients with advanced heart failure, preserved RV function as indicated by an echocardiographically derived RV shortening >1.25 c m is a strong predictor of survival. (C)1998 by Excerpta Medico, Inc.