Abstract 9586: Prognostic Impacts of Changes in Right Ventricular Fractional Area Change in Patients with Heart Failure

Abstract

Background: It has been reported that changes in left ventricular ejection fraction (LVEF) is associated with further prognosis in patients with heart failure (HF). We aimed to examine prognostic impact of changes in right ventricular fractional area change (RVFAC) on risk of cardiac event including cardiac death and worsening HF in HF patients. Methods and Results: We enrolled consecutive 480 hospitalized patients with decompensated HF and measured RVFAC with echocardiography at discharge (1 st examination) and post discharge in the outpatients setting (2 nd examination). RVFAC at 1 st examination of 480 HF patients were above 35% in 314 (65.4%), 25-35% in 108 (22.5%), and less than 25% in 58 (12.1%) patients. Next, based on RVFAC changes from 1 st to 2 nd examination, these patients were categorized into four groups: 1) U-preserved (unchanged and preserved-RVFAC, n=235, 49.0%); 2) Recovered-RVFAC (improvement in at least one category from 1 st to 2 nd examination, n=106, 22.1%); 3) U-reduced (unchanged and reduced-RVFAC, n=47, 9.8%); and 4) Worsened-RVFAC (deterioration of at least one category from 1 st to 2 nd examination, n=92, 19.2%). There was only a weak correlation between RVFAC change and LVEF change (R=0.16, P<0.01). Multivariate logistic regression analysis revealed that anemia and chronic kidney disease were predictors of Worsened-RVFAC. In the Kaplan-Meier analysis ( Figure ), RVFAC at 1 st examination was not associated with cardiac event rate. However, RVFAC changes from 1 st to 2 nd examination was associated with cardiac event rate. In the multivariable Cox proportional hazard analysis, Worsened-RVFAC was an independent predictor of cardiac event rate (vs. U-preserved-RVFAC, HR 2.25, P<0.01; vs. Recovered-RVFAC, HR 2.75, P<0.01). Conclusions: The HF patients with worsened-RVFAC are associated with adverse prognosis. RVFAC changes are important for deciding treatment and predicting prognosis in HF patients.