Background: Not only the degree of right ventricular (RV) dysfunction but also RV dilatation are associated with poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). We have tested the novel concept that RV dilatation per se should be considered as a form of RV dysfunction and integrating the information about RV size and degree of dysfunction into one parameter would provide superior prognostic information.
Methods: A total of 847 stable patients with advanced HFrEF (57.4± 11.3 years, 67.7% NYHA III/IV, LVEF 23.6± 5.8%) were prospectively followed for a median of 1126 (IQRs 410; 1781) days for occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support.
Results: RV size was significantly associated with adverse outcome even when adjusted for RV dysfunction grade, LV-ejection fraction, LVEDD, age and HF etiology (p< 0.0001). The prognostic power of this parameter was further improved by indexing to BSA (RVD1i) (p<0.05). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade only (∆AUC >3.0, p< 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p >0.50) independent of tricuspid regurgitation and severity of pulmonary hypertension (Fig. 1).
Conclusions: RV dilatation should be considered as a form of RV dysfunction in HFrEF patients. The information about RV size and the degree of dysfunction should be integrated into one parameter that provides superior prognostic information.
