Prognostic value and characteristics of patients with acute cardiac failure and right ventricle dysfunction

Introduction: The evaluation of the prognosis of pati-ents with acute cardiac failure (ACF) from the echocar-diographic point of view focused in the previous years especially on the function of the left ventricle, mitral regurgitation and ischemic etiology. In the last decade, right ventricular (RV) function has come to the attenti-on of clinicians, adding value to prognostic data.

Objective: Evaluation of the short-term prognosis of the echocardiographic parameters for quantification of RV function and pulmonary vascular resistance. Cha-racterization of patients with RV dysfunction from the point of view of ACF etiology.

Methods: Retrospective study of 228 patients hospitali-zed with severe ACF, chronic decompensated heart fa-ilure (CDHF) cls IV NYHA and acute pulmonary ede-ma except of acute coronary syndrome (APE nonACS) in the Cardiology Clinic of EC Hospital „St. Panteli-mon“, Bucharest, between 01.01.2016 – 31.12.2016. Anamnestic, clinical and paraclinic data (biological and echocardiographic data on the systolic and dias-tolic function of LV, the right atrioventricular gradient (RAVG), pulmonary artery acceleration time (ATAP), the planimetric trip of the tricuspid ring (TAPSE) were analyzed. Clinical and paraclinical parameters have been correlated with intra-hospital mortality (IM). Pa-tients with RV dysfunction have been analyzed in rela-tion to clinical form and substrate. Three types of sub-strate were taken for analysis: Ischemic Substrate (IS), Primary Valvular (VS), and Hypertensive (SH).

Results: 136 patients with CDHF, 92 patients with APE nonACS. Right ventricular dysfunction, expressed as TAPSE <17mm, a threshold value obtained by ROC curve analysis (p<0.01), was statistically significant associated with IM for both clinical forms (p<0.01). Distribution of patients in relation to RV dysfunction (TAPSE <17mm): 29% patients with TAPSE<17mm, 18% CDHF, 11% APE nonACS, statistically insignifi-cant (SI) differences. In CDHF subgroup analysis based on substrate for TAPSE <17mm: 13% IS, 9%VS, 3%HS. The IM analysis in the substrate relationship of RV dys-function showed prognostic value only for IS (p=0.01) and for HS (p<0.01), and in CDHF for IS (p<0.01) and VS (p<0.01). RAVD was associated with MI for both clinical forms, with a ROC curve value of 45mmHg (p<0.01) in APE nonACS and 49mmHg (p<0.01) in CDHF. The prognostic value of this parameter is mai-ntained for VS (p< 0.02) and HS (p<0.01) in non-ACE APE and VS (p<0.01) in CDHF. TAP was SS associated with IM in APE non-ACS with a 102 ms threshold va-lue (p<0.01). Prognostic value has been maintained at the analysis based on the substrate just for HS (p<0.01). Conclusions: T he echocardiographic parameters that quantify RV function and pulmonary vascular resistan-ce were significantly associated with IM in our paper for both clinical forms. The value of these parameters changes when the evaluation is made according to their etiology. Patients presenting CDHF and those with IS regardless of clinical form have associated, in higher percentage, SI, VD dysfunction.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)