Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure
Abstract Background The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. Results This study comprised 195 patients, aged between 18 and 80 years, with acute left-s...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-01-01
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| Series: | The Egyptian Heart Journal |
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| Online Access: | https://doi.org/10.1186/s43044-023-00432-8 |
| _version_ | 1827388426836508672 |
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| author | Mirna M. Shaker Hesham S. Taha Hossam I. Kandil Heba M. Kamal Hossam A. Mahrous Ahmed A. Elamragy |
| author_facet | Mirna M. Shaker Hesham S. Taha Hossam I. Kandil Heba M. Kamal Hossam A. Mahrous Ahmed A. Elamragy |
| author_sort | Mirna M. Shaker |
| collection | DOAJ |
| description | Abstract Background The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. Results This study comprised 195 patients, aged between 18 and 80 years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1 year due to non-cardiac causes were excluded. The study participants’ mean age was 57.7 ± 10.9 years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV S' < 9.5 cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. Conclusions RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF. |
| first_indexed | 2024-03-08T16:17:38Z |
| format | Article |
| id | doaj.art-be22bf2e91d84e01894031b86cc2eef5 |
| institution | Directory Open Access Journal |
| issn | 2090-911X |
| language | English |
| last_indexed | 2024-03-08T16:17:38Z |
| publishDate | 2024-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Heart Journal |
| spelling | doaj.art-be22bf2e91d84e01894031b86cc2eef52024-01-07T12:31:46ZengSpringerOpenThe Egyptian Heart Journal2090-911X2024-01-0176111810.1186/s43044-023-00432-8Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failureMirna M. Shaker0Hesham S. Taha1Hossam I. Kandil2Heba M. Kamal3Hossam A. Mahrous4Ahmed A. Elamragy5Department of Cardiology, Faculty of Medicine, Cairo UniversityDepartment of Cardiology, Faculty of Medicine, Cairo UniversityDepartment of Cardiology, Faculty of Medicine, Cairo UniversityDepartment of Cardiology, Faculty of Medicine, Cairo UniversityDepartment of Cardiology, Faculty of Medicine, Cairo UniversityDepartment of Cardiology, Faculty of Medicine, Cairo UniversityAbstract Background The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. Results This study comprised 195 patients, aged between 18 and 80 years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1 year due to non-cardiac causes were excluded. The study participants’ mean age was 57.7 ± 10.9 years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV S' < 9.5 cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. Conclusions RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.https://doi.org/10.1186/s43044-023-00432-8Acute heart failureRight ventricular dysfunctionEchocardiographyCardiovascular deathHeart failure hospitalization |
| spellingShingle | Mirna M. Shaker Hesham S. Taha Hossam I. Kandil Heba M. Kamal Hossam A. Mahrous Ahmed A. Elamragy Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure The Egyptian Heart Journal Acute heart failure Right ventricular dysfunction Echocardiography Cardiovascular death Heart failure hospitalization |
| title | Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure |
| title_full | Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure |
| title_fullStr | Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure |
| title_full_unstemmed | Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure |
| title_short | Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure |
| title_sort | prognostic significance of right ventricular dysfunction in patients presenting with acute left sided heart failure |
| topic | Acute heart failure Right ventricular dysfunction Echocardiography Cardiovascular death Heart failure hospitalization |
| url | https://doi.org/10.1186/s43044-023-00432-8 |
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