Added predictive value of right ventricular ejection fraction compared with conventional echocardiographic measurements in patients who underwent diverse cardiovascular procedures

Abstract

Background and AimRight 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 MethodsOne 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.ResultsTwenty-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±4mm), and RV systolic pressure (36±15 vs. 39±15mmHg) 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).ConclusionsConventional 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

Tricuspid regurgitation and right ventricular contraction pattern in heart failure with reduced ejection fraction: a 3D echocardiography study

“…On the other hand, speckle-tracking refers only to the longitudinal shortening of the RV using a single apical four-chamber cut and neglects the two other motion directions of the ventricular contraction. Thus, the use of 3D echocardiography is essential for a comprehensive assessment of RV volumes and function that goes beyond the importance of longitudinal shortening (21). Therefore, in our study, we utilized 3D evaluation of the RV, and as anticipated, patients with significant TR showed larger RV volumes.…”

Superior prognostic value of three-dimensional echocardiography-derived right ventricular ejection fraction: a meta-analysis

“…Four studies were prospective, while six were retrospective. Only three studies reported associations with all-cause mortality, 13,22,24 the others reported composite cardiopulmonary endpoints (Table 1). We assessed the risk of bias within the studies using the QUIPS tool (Supplementary Figure 1).…”

“…In three instances (including 3-3 studies), there was an apparent overlap between the patient cohorts; 9,13-17 therefore, studies with a higher number of participants were included. 13,15,17 Overall, ten 13,15,[17][18][19][20][21][22][23][24] independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE (n=8), 13,16,18,[20][21][22][23][24] or FAC (n=7), 13,[19][20][21][22][23][24] or FWLS (n=7), 17,[19][20][21][22][23][24] on clinical outcomes (all-cause mortality and/or cardiopulmonary adverse events) as HRs. Four studies were prospective, while six were retrospective.…”

“…Three studies included patients with pulmonary hypertension exclusively, 15,17,21 one included patients with COVID-19 only, 24 one included patients with dilated cardiomyopathy only, 23 one included patients with aortic stenosis only, 19 one included heart failure patients with preserved left ventricular (LV) EF (HFpEF) only, 20 and the remaining three studies included populations with a mixture of cardiovascular diseases. 13,18,22 Outcomes Table 1 contains the definitions of endpoints assessed in each included study. Among the 1928 patients, 394 (20.4%) reached the endpoint of all-cause mortality and/or adverse cardiopulmonary events.…”

Association of Right Ventricular Functional Parameters With Adverse Cardiopulmonary Outcomes: A Meta-analysis

“…RVEF might be a universal biomarker that refines risk stratification. 10 12,14,16-23 independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE (n = 8), 12,15,17,[19][20][21][22][23] or FAC (n = 7), 12,[18][19][20][21][22][23] or FWLS (n = 7) 16,[18][19][20][21][22][23] on clinical outcomes (allcause mortality and/or cardiopulmonary adverse events) as HRs. Four studies were prospective, while 6 were retrospective.…”