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

被引:1000
作者
Ghio, S
Gavazzi, A
Campana, C
Inserra, C
Klersy, C
Sebastiani, R
Arbustini, E
Recusani, F
Tavazzi, L
机构
[1] Policlin San Matteo, IRCCS, Dipartimento Cardiol, I-27100 Pavia, Italy
[2] Policlin San Matteo, IRCCS, Direz Sci, I-27100 Pavia, Italy
[3] Policlin San Matteo, IRCCS, Ist Anat Patol, I-27100 Pavia, Italy
关键词
D O I
10.1016/S0735-1097(00)01102-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We sought a better understanding of the coupling between right ventricular 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 right ventricle (RV) is almost exclusively dependent on the afterload that this cardiac chamber must confront, recent studies claim that RV function is an independent prognostic factor in patients with chronic heart failure. METHODS Right heart catheterization was performed in 377 consecutive patients with heart failure. RESULTS During a median follow-up period of 17 +/- 9 months, 105 patients died and 35 underwent urgent heart transplantation. Pulmonary artery pressure and thermodilution-derived RVEF were inversely related (r = 0.66, p < 0.001). 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 patients with pulmonary hypertension, and that the prognosis of these patients was similar to that of the patients with normal PAP. In contrast, when PAP was normal, reduced RV function did not carry an additional risk. CONCLUSIONS These observations emphasize the necessity of combining the right 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.
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页码:183 / 188
页数:6
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