AUTHOR=Berrill Max , Ashcroft Eshan , Fluck David , John Isaac , Beeton Ian , Sharma Pankaj , Baltabaeva Aigul 

TITLE=Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.911053

DOI=10.3389/fcvm.2022.911053

ISSN=2297-055X

ABSTRACT=Aims
The severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long term outcome in AHF.  
Methods 
418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bed-side echocardiography within 24 hours of recruitment.  We retrospectively assessed 8 RV and 5 LV echo parameters of cardiac systolic function   to predict 2-year mortality, using both guideline-directed and study-specific cut-offs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free   wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS and the LV GLSR. 
Results
7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cut-offs similar to international guidelines. A cut-off of <-1.8s-1 mean RV GLSR was associated with worse outcome compared to >-1.8s-1 (HR 2.13 95% CI 1.33-3.40 [p=0.002]). TAPSE:SPAP of >0.027cm/mmHg (vs. <0.027cm/mmHg) predicted worse outcome (HR 2.12 95% CI 1.53-2.92 [p<0.001]). A 3-way comparison of 2-year mortality by LVEF from European Society of Cardiology (ESC) guideline criteria of LVEF >50%, 41-49% and <40% was not prognostic (38.6% vs. 30.9% vs. 43.9% [p=0.10]). Of the 5 parameters of LV systolic function, only an MR dP/dt cut-off of <570mmHg was predictive of adverse outcome (HR 1.63 (95% CI 1.01-2.62 [p=0.047]). 
Conclusion
With cut-offs broadly similar to ESC guidelines we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.