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Right ventricular recovery during follow‐up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction
Author(s) -
Dini Frank Lloyd,
Carluccio Erberto,
Simioniuc Anca,
Biagioli Paolo,
Reboldi Gianpaolo,
Galeotti Gian Giacomo,
Raineri Claudia,
Gargani Luna,
Scelsi Laura,
Mandoli Giulia Elena,
Cannito Antonia,
Rossi Andrea,
Temporelli Pier Luigi,
Ghio Stefano
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.639
Subject(s) - medicine , ejection fraction , hazard ratio , heart failure , cardiology , confidence interval , proportional hazards model , clinical endpoint , survival analysis , randomized controlled trial
Aims A compromised tricuspid annular plane systolic excursion ( TAPSE ) is associated with worse survival in patients with chronic heart failure with reduced ejection fraction ( HFrEF ). However, it is not known whether a reversible abnormal TAPSE at follow‐up predicts survival. Our aim was to evaluate whether a reversible abnormal TAPSE is associated with a better survival in patients with chronic HFrEF . Methods and results A complete echocardiography was performed in 706 patients with chronic HFrEF ( LVEF ≤45%) at baseline and after 6 ± 3 months. Right ventricular ( RV ) systolic function was evaluated using TAPSE . The study endpoint was all‐cause mortality. At baseline, TAPSE was severely reduced (≤14 mm) in 89 (13%) patients, and slightly reduced (>14 but <18 mm) in 157 (22%) patients. During a median follow‐up of 40 months, 152 patients reached the endpoint. The event rate (per 100 patients/year) was lower in patients with persistently normal TAPSE (≥18 mm, n = 393) [3.3%, 95% confidence interval ( CI ) 2.5–4.3], and in those with reversible TAPSE ( n = 120) (4.6%, 95% CI 3.1–7.0), compared with patients with worsening TAPSE ( n = 90) (11.9%, 95% CI 8.7–16.3), and those with persistently reduced TAPSE ( n = 103) (12.6%, 95% CI 9.3–17.1; log‐rank 69.4, P < 0.0001). A reversible abnormal TAPSE was associated with improved survival at multivariable Cox regression analysis (hazard ratio 0.48, 95% CI 0.29–0.79, P = 0.004). Conclusions Patients with chronic HFrEF who have abnormal TAPSE at baseline but reverse their dysfunction during follow‐up have better survival than patients with either worsened TAPSE or persistently abnormal TAPSE , and similar to that of patients with persistently normal TAPSE .