Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

• Published in: International Heart Journal Vol. 52; no. 2; pp. 119 - 126
• Main Authors: Maekawa, Emi, Inomata, Takayuki, Watanabe, Ichiro, Yanagisawa, Tomoyoshi, Mizutani, Tomohiro, Shinagawa, Hisahito, Koitabashi, Toshimi, Takeuchi, Ichiro, Tokita, Naoki, Inoue, Yusuke, Izumi, Tohru
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 2011
• Subjects: Acute exacerbation; Echocardiography; Female; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - pathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Humans; Low cardiac output; Male; Organ Size; Predictive Value of Tests; Prognosis; Right ventricular dimension; Severity of Illness Index; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - pathology
• DOI: 10.1536/ihj.52.119
• ISSN: 1349-2365

Right ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent long-term outcome in patients with chronic left-sided HF. We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≥ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences. RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters.