Abstract
Abstract Background and aim Right ventricular (RV) ejection fraction (EF) assessed by 3D echocardiography is a powerful measure to detect RV dysfunction. However, its prognostic value in routine clinical practice has been scarcely explored. Accordingly, we aimed at investigating whether RVEF is associated with 2-year all-cause mortality in patients who underwent diverse cardiovascular procedures and to test whether RVEF can overcome conventional echocardiographic parameters in terms of outcome prediction. Patients and methods One hundred and seventy-four patients were retrospectively identified who underwent clinically indicated transthoracic echocardiography comprising 3D acquisitions. The patient population consisted of heart failure with reduced ejection fraction patients (44%), heart transplanted patients (16%), and severe valvular heart disease patients (39%). Beyond conventional echocardiographic measurements, RVEF was quantified by 3D echocardiography. The primary endpoint of our study was all-cause mortality at two years. Results Twenty-four patients (14%) met the primary endpoint. Patients with adverse outcomes had significantly lower RVEF (alive vs. dead; 48 ± 9 vs. 42 ± 9%, P < 0.01). However, tricuspid annular plane systolic excursion (21 ± 7 vs. 18 ± 4 mm), and RV systolic pressure (36 ± 15 vs. 39 ± 15 mmHg) were similar. By Cox analysis, RVEF was found to be associated with adverse outcomes (HR [95% CI]: 0.945 [0.908–0.984], P < 0.01). By receiver-operator characteristic analysis, RVEF exhibited the highest AUC value compared with the other RV functional measures (0.679; 95% CI: 0.566–0.791). Conclusions Conventional echocardiographic measurements may be inadequate to support a granular risk stratification in patients who underwent different cardiac procedures. RVEF may be a robust clinical parameter, which is significantly associated with adverse outcomes.
Highlights
The quantification of ventricular performance is a cornerstone of echocardiographic examinations of nearly every indication
By Cox analysis, RVEF was found to be associated with adverse outcomes (HR [95% confidence intervals (95% CI)]: 0.945 [0.908–0.984], P < 0.01)
By receiver-operator characteristic analysis, RVEF exhibited the highest AUC value compared with the other right ventricular (RV) functional measures (0.679; 95% CI: 0.566–0.791)
Summary
The quantification of ventricular performance is a cornerstone of echocardiographic examinations of nearly every indication. Predictive value of RV ejection fraction function is ejection fraction (EF): robust evidence supports its usefulness because it correlates with clinical signs and symptoms and has established diagnostic and prognostic power in various cardiac diseases [1]. RVEF can be measured only by three-dimensional (3D) imaging methods; there is no appropriate and clinically applied two-dimensional (2D) method that can accurately estimate RV volumes. Certain, dominantly tertiary cardiology departments started to apply 3DE-derived RV quantification in their daily routine to harvest its strong potential in preoperative risk stratification, procedure planning, disease management, and long-term outcome prediction [4]. We aimed at investigating whether RVEF is associated with 2-year all-cause mortality in patients who underwent diverse cardiovascular procedures and to test whether RVEF can overcome conventional echocardiographic parameters in terms of outcome prediction
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