Abstract 11183: A Classificatory Analysis of Right Heart Geometry and Dysfunction Provides Prognostic Stratification in Heart Failure of Any Left Ventricular Ejection

Abstract

Introduction: The prognostic role of the left heart dysfunction is established in heart failure (HF). However, focusing only on left ventricular ejection fraction (LVEF) may be reductive as HF with preserved ejection fraction (HFpEF) yields to poor outcomes, similarly to HF with reduced ejection fraction (HFrEF). Hypothesis: We investigated the prognostic role of the right ventricle (RV) phenotype through a classification based on RV end diastolic diameter (RVEDD) and tricuspid annulus systolic excursion (TAPSE) in chronic HF of any LVEF. Methods: We retrospectively examined two well-defined population of ambulatory patients with chronic HF: severe HFrEF (LVEF≦35%) and HFpEF (LVEF≧55%), all receiving optimal guideline-directed medical and device therapy, followed at a dedicated outpatient HF clinic. Patients were categorized by echocardiography based on RVEDD (cut-off 42 mm) and TAPSE (cut-off 17 mm) into four groups (above and below cut-offs): not dilated and not hypokinetic (NDNH), dilated and not hypokinetic (DNH), not dilated and hypokinetic (NDH) and dilated and hypokinetic (DH). Results: Among 256 patients (mean age 67±12 years, 75% men, 75% HFrEF, 60% ischemic), RVEDD and TAPSE were available for 202. Distribution of NDNH, NDH, DNH and DH is reported in the figure. Over a median follow-up of 4 years, 62 deaths occurred; KM-survival curves are shown in figure. After multivariable adjustment for age, HFpEF/HFrEF, and ischemic etiology, patients with DNH and DH showed increased risk of mortality (HR 2.4 95%CI 1.1-5.1 p=0.024; and 3.4 95%CI 1.7-6.7 p<0.001 respectively) compared to NDNH, with NDH showing comparable risk (HR 1.6 95%CI 0.9-3.7 p=0.232). Conclusions: In chronic HF receiving optimal medical and device therapy, a simple and easy to use RV classificatory analysis is worth of consideration out of LVEF categorization. RV dimensions rather than motility drive the mortality rate independently of age, HFpEF/HFrEF phenotype and HF etiology.