Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure

Abstract

Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.

The number of valvular insufficiency is a strong predictor of cardiovascular and all-cause mortality in hemodialysis patients

“…Green et al reported mitral regurgitation was the only parameters predictive of sudden cardiac death [ 19 ]. Based on the data analysis of 533 patients admitted for first systolic heart failure, Hsiao SH et al also discovered that systolic pulmonary regurgitation was associated with cardiovascular death [ 20 ]. Nevertheless, we found that insufficiency of any one valve was not the independent risk factor for cardiovascular mortality or all-cause mortality, but number of VI ≥ 2 was correlated to both.…”

“…Mitral regurgitation can leads to heart failure by inducing volume overload of the heart [ 24 ]. Systolic pulmonary regurgitation was also considered to correlate with heart failure rehospitalization [ 20 ]. But a study of 639 hospitalized patients with acute heart failure found that moderate or severe tricuspid regurgitation was not associated with readmission for heart failure [ 25 ].…”