Associations Between Echocardiographic Right Heart Measurements With Short-Term Prognosis in Heart Failure: A Prospective Study

Background

Echocardiographic right ventricular (RV) dysfunction is a strong risk determinant for prognosis in patients with heart failure (HF). Although parameters of RV systolic function are widely used to define RV dysfunction, there is scarce data to suggest these parameters are best suited to predict HF-related outcomes.

Aims

We aimed to understand which morphologic or functional parameters are most closely associated with short-term mortality and HF-related hospitalization in patients with HF.

Methods

A total of 191 patients from eight study centers were included to this study. A detailed echocardiographic examination was done at enrollment, and patients were followed up for 6 months via direct interviews or phone calls.

Results

All right-sided echocardiographic parameters other than tricuspid annular plane systolic excursion were associated with outcomes. In a proportional hazards model that included right-heart parameters, RV longitudinal diameter (HR: 1.07, 95%CI: 1.04–1.10, p < 0.001), wall thickness (HR: 1.3, 95%CI: 1.13–1.50, p < 0.001), and tricuspid annular systolic velocity (HR: 0.90, 95%CI: 0.82–0.96, p = 0.02) were found as the independent predictors. However, only RV longitudinal dimension (HR: 1.04, 95%CI: 1.01–1.08, p = 0.01) and RV wall thickness (HR: 1.32, 95%CI: 1.10–1.60, p = 0.004) were associated with short-term outcomes after adjusting for other clinical and left-sided echocardiographic variables. On a Bayesian logistic regression model that included right-sided echocardiography variables, there was strong evidence for including either RV longitudinal diameter (BF₁₀: 190.4) or wall thickness (BF₁₀: 30.7) to the final model.

Conclusion

Parameters of RV morphology were better predictors of short-term outcomes in HF patients.