© 2003 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
Prognostic Importance of the Right Ventricular Function Assessed by Doppler Tissue Imaging
pinarová1
ek2
í1
11st Department of Internal Medicine, St. Anna Hospital, Masaryk University, Brno, Czech Republic
2Centre of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
Received 7 August 2002; received in revised form 19 November 2002; accepted after revision 22 November 2002.
* Address correspondence to: Jaroslav Meluzín, 1st Department of Internal Medicine, St. Anna Hospital, Peka
ská 53, Brno 65691, Czech Republic. Tel: +420-5-4318-2224; Fax: +420-5-4318-2205. jaroslav.meluzin{at}fnusa.cz
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Abstract |
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Aims: We sought to assess whether the peak systolic and diastolic tricuspid annular velocities as indicators of the right ventricular systolic and diastolic function are of prognostic importance in patients with symptomatic heart failure.
Methods and Results: The study included 139 consecutive patients with symptomatic heart failure. Their mean left ventricular ejection fraction was 24% (range, 10–39%); 107 patients (77%) were in functional class III according to the New York Heart Association. All patients underwent clinical and laboratory examination, standard echocardiography completed by the Doppler tissue imaging of the tricuspid annular motion, and the right-sided heart catheterization. They were followed up for cardiac-related death and non-fatal cardiac events including the need for implantation of a cardioverter-defibrillator and hospitalization for heart failure. The median follow-up was 11 months (range, 1–48 months). There were 17 cardiac-related deaths and 23 non-fatal cardiac events. The multivariate stepwise Cox regression modelling revealed three effective predictors for both survival and event-free survival: aetiology of heart failure, left ventricular end-diastolic diameter, and the peak systolic tricuspid annular velocity (Sa). Patients with Sa < 10.8 cm s–1 exhibited worse survival (P=0.048) and event-free survival (P<0.001) compared with those having Sa 
10.8 cm s–1. Risk values of Sa (<10.8 cm s–1) and the left ventricular end-diastolic diameter (>70 mm) were found to be of additive simultaneous influence leading to a very poor prognosis, mainly if aetiology of heart failure was idiopathic dilated cardiomyopathy (P<0.001).
Conclusion: The Sa represents a significant independent predictor of survival and event-free survival in patients with symptomatic heart failure. Its combination with the left ventricular end-diastolic diameter provides a very powerful tool for patient risk stratification.
Keywords: prognosis; heart failure; right ventricular dysfunction; Doppler tissue imaging
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