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The prognostic value of right ventricular function in heart failure is well known. In our study, we aimed to investigate the relation of right ventricular stroke work index (RV SWI), an invasive hemodynamic parameter of right ventricle with prognosis of heart failure and cardiac events.
The study followed up 132 patients admitted to our hospital outpatient clinic between April 2011 - November 2012 with diagnosis of advanced stage heart failure, (104 male, 28 female and age 24-81 years). The files of patients were searched retrospectively and patients called by phone for ascertain of prognosis. All patients’ medical history, demographic characteristics, cardiovascular risk factors, comorbid illnesses, New York Heart Association functional class, echocardiographic evaluations and basal right heart catheterizations performed were detected. The relation of RV SWI values with ventricular assist device insertion, heart transplantation, cardiac resyncronisation therapy, rehospitalisation due to decompansation composite end-points and with mortality were evaluated. Advanced stage heart failure was defined as ejection fraction < 35% with symptoms and/or signs of heart failure.
In our study, 34 of 132 patients needed to rehospitalization due to cardiac decompansation. Of these patients, 14 have died. In the patients with cardiac decompensation right ventricular"stroke work index" 6.1±2.5 gr/m2/beat and 8.5±3.4 gr/m2/beat in the group without decompensation. Ischemic heart failure ethiology in patients with cardiac decompensation were less frequently (p=0.035), smoking rates were higher (p=0.006) and concomitant diseases were more frequently (p<0.05) than of patients without cardiacdecompansition. Medication using frequency were significantly lower in the group with cardiac decompensation than without decompansion.During 20 months follow-up, total mortality was observed in 18 (13.6%) patients. The relation between RV SWI and mortality did not reach statistical significance (p=0.773). In patients who died, mean RV SWI value was 7.5±3.4 g/m2/beat, those who survived had RV SWI mean value 8.0±3.4 gr/m2/beat. The left ventricular ejection fraction (p<0.001) and right ventricle systolic diameter (p<0.001) had statistically significant relation with mortality. In patients who survived without cardiac events RV SWI value was significantly different from those who survived with cardiac events (p=0.003), indicating that decreased RV SWI is associated with increased cardiac event rates among patients with advanced stage heart failure.
Right ventricular stroke work index is a predictor of event free survival among patients with advanced stage heart failure. Our study did not support RV SWI as single parameter of predictor of mortality. Risk models consisting of invasive, non-invasive and clinical parameters should be developed for prediction of all-cause mortality in advanced stage heart failure.
|Parameters||Patients who died||Patients who survived||p|
|Male n (%)||15 (83,3)||89 (78,1)||0,612|
|LV EF (%)||24±2||27±4||<0,001|
|Duration of heart failure (year)||3,8±1,7||4,6±3,6||0,869|
|NYHA functional class, n (%)||13 (72,3)||38 (33,4)||0,001|
|Ischemic etiology of heart failure, n (%)||8 (44,4)||80 (70,2)||0,031|
|Rervascularization, n (%)||7 (38,9)||61 (53,5)||0,249|
|CRT-D implantation, n (%)||6 (33,3)||29 (25,4)||0,481|
|Diabetes Mellitus n (%)||5 (27,8)||30 (26,3)||0,896|
|Hyperlipidemia, n (%)||4 (22,2)||56 (49,1)||0,033|
|Hypertension, n (%)||7 (38,9)||66 (57,9)||0,132|
|Smoking, n (%)||5 (27,8)||26 (22,8)||0,644|
|Family history, n (%)||3 (16,7)||9 (7,9)||0,229|
|Chronic obstructive lung disease, n (%)||5 (%27,8)||21 (%18,4)||0,354|
|Chronic renal failure, n (%)||9 (%50)||30 (26,3)||0,041|
|Cerebrovascular event, n (%)||2 (%11,1)||6 (%5,3)||0,334|
|Hepatic dysfunction, n (%)||3 (%16,7)||4 (%3,5)||0,021|
|Anemia, n (%)||5 (%27,8)||20 (%17,5)||0,303|