Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction

Abstract

BackgroundRecent studies suggest the significance of right ventricular (RV) function in the outcome in patients with left ventricular dysfunction (LVSD); however, global assessment of RV remains to be determined by echocardiogram because of its complex geometry. This study aimed to validate RV outflow tract fractional shortening (RVOT-FS) in the evaluation of RV function and its prognostic value in patients with LVSD.MethodsThis study included eighty-one patients (62 ± 17 years, mean ± SD, male 79%) with reduced LV ejection fraction (LVEF) (≤40%). Two-dimensional echocardiogram of the parasternal short axis view was obtained at the level of the aortic root, and RVOT-FS was calculated as the ratio of end-diastole minus end-systole dimension to end-diastole dimension.ResultsRVOT-FS ranged from 0.04 to 0.8 (0.3 ± 0.2, mean ± SD), and correlated with LVEF (r = 0.33, p = 0.0028), RV fractional area change (r = 0.37, p = 0.0008) and brain natriuretic peptide level (r = -0.38, p = 0.0005). In Cox multivariate regression analysis, RVOT-FS [hazard ratio (HR) 0.028, 95% confidence interval (CI): 0.002-0.397]; p = 0.008] and New York Heart Association functional class III-IV [HR 2.233, 95% CI: 1.048-4.761]; p = 0.037] were independent factors to predict the events. During a median follow-up period of 319 days (1 to 1862 days), patients with RVOT-FS ≥ 0.2 showed a higher event-free rate than those < 0.2 by Kaplan-Meier analysis (log-rank test, p = 0.0016).ConclusionsOur data suggest that RVOT-FS is a simple parameter reflecting the severity of both ventricular function in patients with LVSD. In addition, RVOT-FS might be useful to predict adverse outcomes in such a patient population.

Right ventricular outflow tract systolic excursion and fractional shortening: Can these echocardiographic parameters be used for the assessment of right ventricular function?

“…[16] ( r = 0.33 with P = 0.0028) and from that reported by Asmer et al . [12] ( r = 0.55 with P < 0.0003).…”

Echocardiographic linear fractional shortening for quantification of right ventricular systolic function—A cardiac magnetic resonance validation study

“…Yamaguchi et al, studying 81 patients with left heart failure, reported that RV fractional shortening (measured in parasternal long axis) correlated with fractional area change (r=0.37; p=0.0008) as well as BNP-evidenced heart failure severity (r=−0.38, p=0005), and independently predicted event free survival. [13] Similarly, Lindqvist et al reported that RV fractional shortening (in parasternal short axis) differed between a cohort of 112 patients and controls (p<0.0001), and correlated with RV long axis excursion (i.e. TAPSE).…”

Echocardiography of Chronic Right Heart Failure

“…RVOT fs has been shown to be more sensitive to elevation in pulmonary pressure than TAPSE and of prognostic value in heart failure ( Fig. 10.25) [100,101]. Its limitation is that it is a measure of only one segment of the RV, the RVOT, which contributes less to overall RV function than the inflow tract [102].…”