Different prognostic significance of right and left ventricular diastolic dysfunction in heart failure

Background: Left (LV) and right (RV) ventricular diastolic dysfunction is c ommon in heart failure but the prognostic value of RV diastolic dysfunction is not known. Hypothesis: As a follow-up to a previously undertaken study, this study was carried out to investigate whether LV and RV diastolic dysfunction affect prognosis differently and, in addition, whether changes in diastolic fillin g patterns over time correlate with clinical outcome. Methods: We studied a cohort of 105 patients (mean age 62.7 +/- 1.3 years, 66% male) with heart failure (ejection fraction < 50%) by Doppler echocardi ography in both RV and LV. Results: An LV restrictive filling pattern (RFP) was present in 48% of the patients and, when compared with non-RFP subgroups, it was associated with poorer systolic function, higher New York Heart Association functional clas s, and higher cardiac mortality at 1 year (all p < 0.001). The coexistence of an LV-RFP and poor LV systolic function (ejection fraction < 25%) marked ly decreased the 1-year survival that was significant when compared with ot her subgroups (p = 0.001). In contrast, RV diastolic dysfunction that occur red in 21% of patients was not a prognostic factor for mortality either alo ne or in combination with LV diastolic dysfunction, but predicted nonfatal hospital admissions for heart failure or unstable angina (p = 0.016). Conclusion: An LV restrictive filling pattern is a powerful predictor of a poor prognosis, especially when combined with low ejection fraction, but in this study RV diastolic dysfunction did not appear to be an independent pr edictor of subsequent mortality.