Comparison of four right ventricular systolic echocardiographic parameters to predict adverse outcomes in chronic heart failure

Heart failure (HF) has a poor prognosis. Several right ventricular (RV) echocardiographic parameters have been proposed as sensitive markers to detect patients at risk. Our objective was to compare the predictive value of four RV systolic echocardiographic parameters for outcomes in patients with HF. One hundred and thirty-six patients with stable HF and a left ventricular ejection fraction < 35% were assessed for the following: (i) RV fractional area (RVFA), (ii) tricuspid annular plane systolic excursion (TAPSE), (iii) integral of the systolic wave (ISW(tdi)), and (iv) peak systolic velocity (PSV(tdi)). ISW(tdi) and PSV(tdi) were measured using tissue Doppler imaging at the tricuspid annulus. The primary endpoint was death, urgent transplantation, urgent ventricular assist device implantation, or an acute HF episode. During a mean follow-up of 295 days, 33 patients reached the primary endpoint. The cut-off thresholds for RVFA, TAPSE, PSV(tdi), and ISW(tdi) defined using receiver-operating characteristic curves were 36.8%, 13.5 mm, 9.5 cm s(-1), and 1.75 cm, respectively. On Cox multivariate analysis, NYHA, log BNP, and only PSV(tdi) from the RV systolic parameters were found to be independent predictors of outcome. PSV(tdi) is a strong independent predictor of outcome in HF at a threshold value of 9.5 cm s(-1) and appears to be superior to other RV systolic echocardiographic parameters.