Heart failure with preserved right ventricular ejection fraction in postoperative adults with congenital heart disease: A subtype of severe right ventricular pathophysiology. (1st June 2016)

• Record Type: Journal Article
• Authors: Ohuchi, Hideo; Hayama, Yosuke; Negishi, Jun; Noritake, Kanae; Iwasa, Toru; Miyazaki, Aya; Yamada, Osamu; Shiraishi, Isao
• Is Part Of: International journal of cardiology. Volume 212(2016)
• Page Start: 223
• Page End: 231
• Publication Date: 2016-06-01
• Subjects: Adult congenital heart disease -- Right ventricle -- Preserved ejection fraction -- Heart failure; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.03.011
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Right ventricle (RV) may determine heart failure (HF) severity in adults with congenital heart disease (ACHD). However, the association of RV properties with clinical profiles remains unclear. Purpose: To clarify the associations of RV properties with biomarkers, exercise capacity, and unscheduled hospitalization (USH) in postoperative ACHD patients. Methods and results: We evaluated determinants of RV end-diastolic volume (EDVI, ml/m 2 ) and pressure (EDP, mmHg) in 260 patients who were divided into 4 groups, i.e., those with RVEDVI < 100 and EDP ≥ 10 (A, n = 49, 19%), those with RVEDVI ≥ 100 with EDP ≥ 10 (B, n = 22), those with RVEDVI < 100 and EDP < 10 (C, n = 134), and those with RVEDVI ≥ 100 and EDP < 10 (D, n = 55). EDVI, EDP, and ejection fraction (EF, %) of the RV were independently associated with the corresponding value of the left ventricle (LV) (p < 0.0001 for all). Group A had a RV–EF of 53 ± 8 and was defined HF with preserved RV–EF (RV–HFpEF). Younger age, lower platelet count, and elevated plasma γ-glutamyltransferase independently predicted the RV–HFpEF. When the presence of pulmonary hypertension and LV–HFpEF was included in the analysis, these two factors independently predicted the presence of RV–HFpEF (p < 0.05–0.001). On multivariate analysis, older age, number of surgeries, cardiac index, and RV systolic pressure independently determined peak oxygen uptake (PVO2, p < 0.05) and RV outflow reconstruction independently predicted USH. The RV–HFpEF group showed the lowest PVO2 and highest incidence of USH among the 4 groups (p < 0.05). Conclusions: Impaired RV characteristics, especially RV–HFpEF, with liver dysfunction and lower platelet count predicted lower exercise capacity with a poorer prognosis in postoperative ACHD patients.