The right ventricle: pairing structural with functional assessment. (14th October 2021)

• Record Type: Journal Article
• Authors: Rocha, B; Cunha, G; Strong, C; Maltes, S; Brizido, C; Aguiar, C; Mendes, M
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Haemodynamics of Heart Failure; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0760
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Right Ventricular (RV) dysfunction is a well-recognized prognostic marker in the natural history of left-sided Heart Failure (HF). Common experience dictates that structural and functional evaluation are often seemingly discrepant. We aimed to evaluate the correlation between RV function by transthoracic echocardiography (TTE) and Right Heart Catheterization (RHC) parameters, and their prognostic value in patients with HF. Methods: We designed a retrospective single-centre study of patients with advanced HF referred to TTE and RHC as part of Heart Transplant candidacy evaluation, from 2010 to 2019. Pulmonary Hypertension (PH) was defined by a mean pulmonary artery pressure (mPAP) ≥25mmHg. Patients with PH other than Group II (WHO) PH were excluded. In appropriate cases, vasodilator challenge with inhaled NO was performed. The primary endpoint was a composite of death, heart transplant or HF hospitalization at 6 months. Results: The cohort was comprised of 68 patients (mean age 56±11 years, 73.5% male, ischaemic HF 44.1%). Most patients had PH (n=61) and TTE evidence of RV dysfunction (n=46). The strongest correlations between RHC and TTE parameters were moderate at best – mPAP, pulmonary capillary wedge pressure and central venous pressure with E/A ratio (Pearson r 0, 461, 0, 533 and 0, 543, respectively; p<0.05); and RV stroke work index and mPAP with non-invasive estimated systolic pulmonary artery (PA) pressure (Pearson r 0, 483 and 0, 481, respectively; p<0.05). Over a median follow-up of 26 (12–42) months, 53 patients had a primary endpoint event, of whom 36 within 6 months. The best model integrating data from structural and functional assessment to predict the primary endpoint included the systolic PA pressure to stroke volume ratio – i.e. PA elastance (HR per 0.10 units: 2.817; 95% CI 1.030–1.338; p=0.016) – and RV free wall longitudinal strain (HR per −1%: 0.792; 95% CI 0.656–0.956; p=0.015). ROC curve analysis disclosed the best cut-off values as follows: 1.3 (sensitivity 77.2%, specificity 65.6%) and −18% (sensitivity 10.7%, specificity 86.4%), respectively. Conclusion: In a cohort of patients with advanced HF, who were potential candidates for heart transplantation, RV dysfunction was often noted. The model with highest accuracy to predict the primary outcome integrated RV structural with functional data. Additional studies are warranted to define well-validated scores useful in the algorithmic therapeutic decision of advanced HF. Funding Acknowledgement: Type of funding sources: None.