Cor Vasa 2005, 46(2)

Is right ventricular function important for the prognosis of patients with chronic heart failure?

Lenka Špinarová¹, Jiří Toman^1,†, Jaroslav Meluzín¹, Petr Hude¹, Jan Krejčí¹, Hana Pavelčíková¹, Josef Tomandl², Jiří Vítovec¹

¹ I. interní-kardioangiologická klinika, Fakultní nemocnice u sv. Anny a Lékařská fakulta Masarykovy univerzity

² Centrum lékařské chemie a biochemie, Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Aim:
To determine whether right ventricular (RV) function is an important factor for the prognosis of patients with chronic heart failure.


Group of patients:
A total of 155 patients with chronic heart failure, NYHA Class II-IV. All patients had left ventricular (LV) dysfunction with an LV ejection fraction (LVEF) below 40%. Patients were on follow up for 24 to 72 months. Group A (101 patients who were alive) and Group B (54 patients who died or had transplantation), mean age 51.8 ± 8.8 years, 129 men, 26 women, 86 had coronary heart disease, 69 dilating cardiomyopathy.

Method:
Echocardiography to measure LV dimensions, volumes and ejection fraction, tissue Doppler imaging (TDI) of tricuspid annulus movement with measurement of systolic velocity (Sa), early (Ea) and late (Aa) diastolic velocity, right-heart catheterization to determine mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), pulmonary vascular resistance (PVR). Tumor-necrosis factor (TNF-") levels were determined using ELISA.

Results:
Group A patients did not differ from Group B patients in age: 50.4 ± 9.9 vs. 52.5 ± 8.2 years and LV ejection fraction 23.6 ± 6.0 vs. 23.8 ± 5.8%. However, group B patients showed lower Sa reflecting right ventricular (RV) systolic function 10.2 ± 2.2 vs. 11.1 ± 2.3 cm/s, p < 0.03. Patients who died or had transplantation, showed higher pressure values during right-heart catheterization: CVP 8.1 ± 5.1 vs. 6.05 ± 5.1 mm Hg, p < 0.02, MPAP 33.1 ± 11.4 vs. 25.1 ± 11.6 mm Hg, p < 0.0001, PCWP 24.2 ± 9.1 vs. 17.0 ± 9.4 mm Hg, p < 0.00001.


Group B patients had significantly higher TNF-" levels:
146 ± 205 vs. 54 ± 90 pg/ml, p < 0.02.

Conclusion:
Right ventricular dysfunction was more manifest in patients who died or had transplantation compared with survivors. The former also showed higher TNF-" levels. Right ventricular function is an important factor affecting the survival of patients with chronic heart failure.

Keywords: Chronic heart failure; Right ventricle; Prognosis; Tissue Doppler imaging; TNF-"

Published: February 1, 2005  Show citation