2017

150.00 rub.
Buy article
2017/№3

Prognostic significance of the right ventricular function in patients with CHF

Sumin A. N.1, Arkhipov O. G.2
1 – Federal State Budgetary Science Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnovy Bulvar 6, Kemerovo 650002
2 – Federal Budgetary Institution, Rehabilitation Center "Topaz" of the RF Social Insurance Fund, Leskhoznaya 1, Myski 652840, Kemerovo Region

Keywords: chronic heart failure, prognosis, echocardiography, right ventricular function

DOI: 10.18087/rhfj.2017.3.2340

Background. In patients with CHF, damage to the right ventricle (RV) can indicate an unfavorable prognosis; however, the prognostic significance of EchoCG parameters of RV structure and function are insufficiently studied in such patients. Aim. To study prognostic significance of RV systolic and diastolic function parameters in patients with CHF. Materials and methods. 129 patients (mean age, 63 [59-72]; 74 men and 55 women) with NYHA FC I-IV CHF associated with IHD and AH were studied. The prospective observation period was 5 years. The endpoint was cardiovascular death, which occurred in 39 patients; these patients were included into the unfavorable prognosis group. The survivor group consisted of 90 patients. EchoCG was performed for all patients with measuring structural indexes of the right heart; tricuspid annular plane systolic excursion (TAPSE); RV filling flow data; tricuspid flow propagation velocity (TFPV) in the combined color M-mode; data of spectral tissue Doppler imaging of the tricuspid annulus (velocities of spectrum systolic part, st, and spectrum diastolic part, e’t and a’t; their ratio, е’т/а’т; and ratios of the right atrial area to TFPV, RAA/TFPV); RV isovolumic relaxation time (RVIRT); and calculated RV performance index (RVTei index). Results. The groups were comparable by age, gender, anthropometric characteristics, the number of patients with CHF within each FC, and the number of patients with atrial fibrillation and pulmonary hypertension. Among structural indexes of the right heart, the right atrial transverse dimension was noticeably increased in the group of deceased from 36.5 [34-41] to 38 [34-45] mm (р=0.04). These patients also had a significant decrease in TAPSE from 20 [16-24] to 17.0 [15-20] mm; р=0.02. In patients with fatal CHF, the RVTei index was significantly increased from 0.52 [0.39-0.65] to 0.82 [0.59-0.94] (р=0.031) and RVIRT was significantly increased from 80 [74-89] to 95 [86-100] ms (р=0.033). In multiple regression models including the factors that had a weight in the monofactorial model, the following factors showed an independent prognostic significance: increased RVIRT >90 ms (HR=3.66; CI, 1.07-12.55; р=0.035); increased RVTei index >0.8 (HR=7.07; CI, 1.95-25.6; р=0.002); increased RAA/TFPV ratio >0.7 (HR=2.64; CI, 1.13-6.2; р=0.023; and decreased early diastolic tricuspid annular motion velocity, e’t ≤11 cm/sec (HR=2.47; CI, 1.06-5.73; р=0.033). Conclusion. The EchoCG evaluation of RV function has a prognostic value for patients with CHF as evidenced by pronounced correlations of data on RV filling flows and spectral tissue Doppler imaging of the tricuspid annulus with the mortality rate. Comprehensive studying RV structure and function indexes is relevant for prediction of the disease outcome.
  1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI:10.1093/eurheartj/ehw128.
  2. Ахматов Я. Р., Абдуллаев Т. А., Марданов Б. У., Ганиева Н. П., Цой И. А. Прогноз жизни больных кардиомиопатией с поражением правого желудочка. Журнал Сердечная Недостаточность. 2014;15(3):168–71 [Axmatov Ya. R., Abdullaev T. A., Mardanov B. U., Ganieva N. P., Czoj I. A. Prognoz zhizni bol`ny`x kardiomiopatiej s porazheniem pravogo zheludochka. Zhurnal Serdechnaya Nedostatochnost`. 2014;15(3):168–71].
  3. Cenkerova K, Dubrava J, Pokorna V, Kaluzay J, Jurkovicova O. Right ventricular systolic dysfunction and its prognostic value in heart failure with preserved ejection fraction. Acta Cardiol. 2015;70(4):387–93.
  4. van Kessel M, Seaton D, Chan J, Yamada A, Kermeen F, Butler T et al. Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values. Int J Cardiovasc Imaging. 2016;32(6):905–12. DOI:10.1007/s10554-016-0862-8.
  5. Ghio S, Temporelli PL, Klersy C, Simioniuc A, Girardi B, Scelsi L et al. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail. 2013;15(4):408–14. DOI:10.1093/eurjhf/hfs208.
  6. Axell RG, Hoole SP, Hampton-Till J, White PA. RV diastolic dysfunction: time to reevaluate its importance in heart failure. Heart Failure Reviews. 2015;20(3):363–73. DOI:10.1007/s10741-015-9472-0.
  7. Murch SD, La Gerche A, Roberts TJ, Prior DL, MacIsaac AI, Burns AT. Abnormal right ventricular relaxation in pulmonary hypertension. Pulmonary Circulation. 2015;5(2):370–5. DOI:10.1086/681268.
  8. Bistola V, Parissis JT, Paraskevaidis I, Panou F, Nikolaou M, Ikonomidis I et al. Prognostic value of tissue Doppler right ventricular systolic and diastolic function indexes combined with plasma B-type natriuretic Peptide in patients with advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2010;105(2):249–54. DOI:10.1016/j.amjcard.2009.08.682.
  9. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713; quiz 786-788. DOI:10.1016/j.echo.2010.05.010.
  10. Cortina C, Bermejo J, Yotti R, Desco MM, Rodríguez-Pérez D, Antoranz JC et al. Noninvasive assessment of the right ventricular filling pressure gradient. Circulation. 2007;116(9):1015–23. DOI:10.1161/CIRCULATIONAHA.107.691154.
  11. Сумин А. Н., Архипов О. Г. Показатели диастолической функции правого желудочка при различной выраженности легочной гипертензии у больных хроническим легочным сердцем. Журнал Сердечная Недостаточность. 2012;13(1):13–8. DOI:10.18087/rhfj.2012.1.1625 [Sumin A. N., Arxipov O. G. Pokazateli diastolicheskoj funkczii pravogo zheludochka pri razlichnoj vy`razhennosti legochnoj gipertenzii u bol`ny`x xronicheskim legochny`m serdczem. Zhurnal Serdechnaya Nedostatochnost`. 2012;13(1):13–8. DOI:10.18087/rhfj.2012.1.1625].
  12. Guendouz S, Rappeneau S, Nahum J, Dubois-Randé J-L, Gueret P, Monin J-L et al. Prognostic significance and normal values of 2D strain to assess right ventricular systolic function in chronic heart failure. Circ J. 2012;76(1):127–36.
  13. Краснова О. А., Ситникова М. Ю., Иванов С. Г., Федотов П. А. Эффективность Сиэттлской модели выживаемости при ХСН для определения долгосрочного прогноза мужчин с ишемической болезнью. Российский кардиологический журнал. 2012;(5):58–62 [Krasnova O. A., Sitnikova M. Yu., Ivanov S. G., Fedotov P. A. E`ffektivnost` Sie`ttlskoj modeli vy`zhivaemosti pri XSN dlya opredeleniya dolgosrochnogo prognoza muzhchin s ishemicheskoj bolezn`yu. Rossijskij kardiologicheskij zhurnal. 2012;(5):58–62].
  14. Шляхто Е. В., Ситникова М. Ю., Лелявина Т. А., Иванов С. Г., Трукшина М. А., Федотов П. А. и др. Современные алгоритмы оценки прогноза у больных хронической сердечной недостаточностью. Сравнительная характеристика МНП-возрастной модели выживаемости (Нева –75) и сиэттлской модели сердечной недостаточности (SEATTLE HEART FAILURE MODEL) у больных 75–85 лет. Журнал Сердечная Недостаточность. 2009;10(1):4–7. DOI:10.18087/rhfj.2009.1.1153 [Shlyaxto E. V., Sitnikova M. Yu., Lelyavina T. A., Ivanov S. G., Trukshina M. A., Fedotov P. A. i dr. Sovremenny`e algoritmy` oczenki prognoza u bol`ny`x xronicheskoj serdechnoj nedostatochnost`yu. Sravnitel`naya xarakteristika MNP-vozrastnoj modeli vy`zhivaemosti (Neva –75) i sie`ttlskoj modeli serdechnoj nedostatochnosti (SEATTLE HEART FAILURE MODEL) u bol`ny`x 75–85 let. Zhurnal Serdechnaya Nedostatochnost`. 2009;10(1):4–7. DOI:10.18087/rhfj.2009.1.1153].
  15. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28(1):1–39.e14. DOI:10.1016/j.echo.2014.10.003.
  16. Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation. 1983;68(2):302–9.
  17. Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119. DOI:10.1093/eurheartj/ehv317.
  18. Pocock SJ, Ariti CA, McMurray JJV, Maggioni A, Køber L, Squire IB et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013;34(19):1404–13. DOI:10.1093/eurheartj/ehs337.
  19. Арутюнов А. Г. Стратегия выбора шкал риска, прогноза и тяжести пациентов с синдромом острой декомпенсации ХСН. Российский кардиологический журнал. 2013;(2):50–5 [Arutyunov A. G. Strategiya vy`bora shkal riska, prognoza i tyazhesti paczientov s sindromom ostroj dekompensaczii XSN. Rossijskij kardiologicheskij zhurnal. 2013;(2):50–5].
  20. Desai RV, Guichard JL, Mujib M, Ahmed MI, Feller MA, Fonarow GC et al. Reduced right ventricular ejection fraction and increased mortality in chronic systolic heart failure patients receiving β-blockers: insights from the BEST trial. Int J Cardiol. 2013;163(1):61–7. DOI:10.1016/j.ijcard.2011.05.051.
  21. Meyer P, Desai RV, Mujib M, Feller MA, Adamopoulos C, Banach M et al. Right ventricular ejection fraction <20% is an independent predictor of mortality but not of hospitalization in older systolic heart failure patients. International Journal of Cardiology. 2012;155(1):120–5. DOI:10.1016/j.ijcard.2011.05.046.
  22. Murninkas D, Alba AC, Delgado D, McDonald M, Billia F, Chan WS et al. Right ventricular function and prognosis in stable heart failure patients. J Card Fail. 2014;20(5):343–9. DOI:10.1016/j.cardfail.2014.01.018.
  23. Tei C, Dujardin KS, Hodge DO, Kyle RA, Tajik AJ, Seward JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol. 1996;28(3):658–64.
  24. Schiller NB, Kwan DM. The Tei Index as an Expression of Right Ventricular Impairment and Recovery. JACC: Cardiovascular Imaging. 2009;2(2):150–2. DOI:10.1016/j.jcmg.2008.11.006.
  25. Rajasekhar D SKC, Boochi Babu M VV. The Immediate and Short Term Impact of Successful Percutaneous Transvenous Mitral Commissurotomy on Right Ventricular Function. Journal of Cardiovascular Diseases & Diagnosis. 2015;03(05):2–7. DOI:10.4172/2329-9517.1000217.
  26. Bréchot N, Gambotti L, Lafitte S, Roudaut R. Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure. Eur J Echocardiogr. 2008;9(4):547–54. DOI:10.1093/ejechocard/jen121.
  27. Fahmy Elnoamany M, Abdelraouf Dawood A. Right Ventricular Myocardial Isovolumic Relaxation Time as Novel Method for Evaluation of Pulmonary Hypertension: Correlation with Endothelin-1 Levels. Journal of the American Society of Echocardiography. 2007;20(5):462–9. DOI:10.1016/j.echo.2006.10.003.
  28. Saguner AM, Vecchiati A, Baldinger SH, Rüeger S, Medeiros-Domingo A, Mueller-Burri AS et al. Different prognostic value of functional right ventricular parameters in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Cardiovasc Imaging. 2014;7(2):230–9. DOI:10.1161/CIRCIMAGING.113.000210.
  29. Meluzin J, Spinarová L, Hude P, Krejcí J, Dusek L, Vítovec J et al. Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure. Int J Cardiol. 2005;105(2):164–73. DOI:10.1016/j.ijcard.2004.12.031.
  30. Lee S-E, An HY, Im JH, Sung JM, Cho I-J, Shim CY et al. Screening of Mechanical Complications of Dilated Pulmonary Artery Related to the Risk for Sudden Cardiac Death in Patients with Pulmonary Arterial Hypertension by Transthoracic Echocardiography. J Am Soc Echocardiogr. 2016;29(6):561–6. DOI:10.1016/j.echo.2016.02.002.
Sumin A. N., Arkhipov O. G. Prognostic significance of the right ventricular function in patients with CHF. Russian Heart Failure Journal. 2017;18(3):190–200

To access this material please log in or register

Register Authorize
Ru En