Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure

OBJECTIVES We sought a better understanding of the coupling between right v entricular ejection fraction (RVEF) and pulmonary artery pressure (PAP), as it might improve the accuracy of the prognostic stratification of patients with heart failure. BACKGROUND Despite the long-standing view that systolic function of the rig ht ventricle (RV) is almost exclusively dependent on the afterload that thi s cardiac chamber must confront, recent studies claim that RV function is a n independent prognostic factor in patients with chronic heart failure. METHODS Right heart catheterization was performed in 377 consecutive patien ts with heart failure. RESULTS During a median follow-up period of 17 +/- 9 months, 105 patients d ied and 35 underwent urgent heart transplantation. Pulmonary artery pressur e and thermodilution-derived RVEF were inversely related (r = 0.66, p < 0.0 01). However, on Cox multivariate survival analysis, no interaction between such variables was found, and both turned out to be independent prognostic predictors (p < 0.001). It was found that RVEF was preserved in some patie nts with pulmonary hypertension, and that the prognosis of these patients w as similar to that of the patients with normal PAP. In contrast, when PAP w as normal, reduced RV function did not carry an additional risk. CONCLUSIONS These observations emphasize the necessity of combining the rig ht heart hemodynamic variables with a functional evaluation of the RV when trying to define the individual risk of patients with heart failure, (J Am Coll Cardiol 2001;37:183-8) (C) 2001 by the American College of Cardiology.