P1557 Predictive significance of right ventricle dysfunction on clinical outcome in patients with HFpEF

Abstract

Background the volume and function of the right ventricle (RV) are the parameters that determine the echo predictive factors of mortality and reduce hospitalizations in patients with heart failure (HF) with reduced ejection fraction (HFrEF). In the concept of the mechanism of the contraction of the heart the global RV ejection fraction consist of combined longitudinal, radial and anteroposterior displacement of the RV walls. RV pump function realized by shortening of the longitudinal axis with the traction of the tricuspid annulus towards the apex; inward movement of the RV free wall; bulging of the interventricular septum into the RV and stretching the free wall over the septum. In case of HFpEF the longitudinal mechanism of RV reduction is more sensitive than others. Longitudinal strain of RV free wall (RVFWS) and 3DRVEF has been proposed as a more accurate and sensitive tool to evaluate RV function in longitudinal displacement of patients with HFpEF. Methods and Results—A total of 73 patients with HFpEF (age, from 26 to 77 years; the clinical manifestations of HFpEF corresponded to NYHA III in 52 patients (71%), NYHA IV in 21 patients (29%); LV EF ≤ 35%) with preserved TAPSE (≤15 mm) underwent RV function assessment using 4DETomTec, speckle-tracking TTE to measure peak RVFWS, GLS, 4DEEF. After a median follow-up period of 36 months, 61 (83%) patients reached the primary composite end point of all-cause death/Heart transplantation. Median RVFWS was −12.3% (interquartile range, −20.3% to −9.4%). Median RVGLS was −15.3% (interquartile range, −21.3% to −10.54%). Median RV4DEF was 31.6% (interquartile range, 21,1% to 36,2%). By Kaplan–Meier plot, RVFWS > -15%, (p < 0,02), GLS >-20%, (p < 0,04), 4DETomtecEF <30% (p < 0,0001) were an independent predictor of outcome in patients with HFpHF. Conclusions: In patients with HFpEF the fast and accurate quantification of RV free-wall strain and 4DTomtecEF provides incremental prognostic information and improved risk stratification.