Relative Prognostic Importance of Left and Right Ventricular Ejection Fraction in Patients With Cardiac Diseases

Abstract

The study aimed (1) to assess the prognostic value of three-dimensional echocardiography (3DE) derived right ventricular (RV) ejection fraction (EF) and (2) to evaluate relative prognostic importance of reduced and preserved left ventricular (LV) EF and RVEF to predict all-cause mortality and cardiac death in a large cohort of patients with cardiac diseases. LV and RV volumes and EF were assessed by 3DE in 394 patients with various cardiovascular diseases. Patients were divided into four groups: (1) normal LVEF (≥50%) and normal RVEF (≥45%), n=183; (2) reduced LVEF (<50%) and normal RVEF (≥45%), n=75; (3) normal LVEF (≥50%) and reduced RVEF (<45%), n=61; (4) reduced LVEF (<50%) and reduced RVEF (<45%), n=75. The patients were followed up for 3.7±1.1years. Reduced 3DE-derived RVEF was associated with all-cause mortality (P<.0001). The four groups had significantly different survival (P<.0001). Both all-cause mortality and cardiac death in patients with reduced RVEF and normal LVEF were significantly higher than in those with reduced LVEF and normal RVEF (P=.0007 and P=.0091, respectively) and did not differ significantly from patients with reduced EF of both ventricles (P=.2198 and P=.0846, respectively). Reduced 3DE-derived RVEF was associated with all-cause mortality and cardiac death in patients with various cardiovascular diseases. Impairment of RVEF carried a significantly higher risk of mortality independent of LVEF.