Prognostic value of right ventricular end-diastolic diameter in patients with chronic systolic heart failure

Abstract

Objective To investigate the prognostic value of right ventricular end-diastolic diameter (RVDD) in patients with chronic systolic heart failure (CHF). Methods A retrospective study was conducted with clinical data of inpatients from 12 third-grade class-A hospitals of Hubei Province between 2000 to 2010, followed up by phone calls. Based on RVDD, patients diagnosed with chronic systolic CHF were divided into four groups: >38 mm, 31-38 mm, 25-30 mm and <25 mm groups; based on prognosis, patients were divided into the death group and the survival group. Of the death group, patients were further divided into the heart failure death subgroup and the sudden cardiac death subgroup. Single-factor and multi-factor Cox survival analyses were conducted to analyze the relationships between RVDD and mortality, including all-cause mortality, CHF mortality and sudden cardiac death (SCD). Results A total of 16681 patients were enrolled in this study. They were followed up for 1-4 years, during which 6453 died. Multivariate Cox survival analysis showed that the mortality risk for patients with RVDD between 25-30 mm, between 31-38 mm, and >38 mm groups was 1.87, 2.41, 3.95 times that for patients with RVDD 38 mm was 3.82 times that for patients with RVDD<25 mm (95%CI: 2.27-5.94, P<0.01). The areas under the ROC curve for death by the best prediction model alone and RVDD combined with the best prediction model were 0.776 (95%CI: 0.768-0.784) and 0.815 (95%CI: 0.808-0.822), respectively. RVDD increased the areas under the ROC curve for all-cause mortality, CHF mortality and sudden cardiac death. The best prediction model combined with RVDD could discriminate between total mortality, heart failure mortality and sudden cardiac death for patients with different causes of death in multivariate analysis. Conclusions RVDD has a predictive value in the prognosis of patients with chronic systolic heart failure. RVDD increases the sensitivity and specificity of the best prediction model for total mortality prediction in patients with chronic systolic heart failure. RVDD increases the sensitivity and specificity of the best prediction model to discriminate between all-cause mortality, heart failure mortality and sudden cardiac death in patients with different causes of death. RVDD>38 mm can serve as an indicator for the assessment of sudden cardiac death in CHF patients. Key words: Heart failure; Heart function tests; Prognosis