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Background: To assess the association between right ventricular (RV) dysfunction, right hemodynamic parameters, and outcomes in patients with preserved ejection fraction.
Methods: Analysis of RV functional parameters including RV size (end-diastolic, systolic area), function (qualitative, area change, Tei index, TAPSE), systolic pulmonary pressure, and end diastolic pulmonary pressure (based on TR velocity at pulmonary valve opening time) from 557 consecutive patients with preserved ejection fraction (EF≥50%; age 64.9+19; 52% female; Charlson index 4.7[2.9, 6.4]). All cause mortality was retrospectively analysed and correlated to echo hemodynamic and co-morbid parameters.
Results: TAPSE and Tei index were the only univariate functional predictors of mortality (HR 0.82[0.69-0.96]; p=0.01 and HR 11.3[2.6-52]; p=0.003, respectively). After adjustment for age and Charlson index TAPSE remained the only functional independent predictor of mortality (p=0.02). TR peak velocity, and at pulmonary valve opening time were obtainable in 62% and 71% of patients, respectively. The best hemodynamic predictor of mortality was TR velocity at pulmonary valve opening time (HR 1.01 [1.005-1.02]; p<0.0001), superior to TR peak velocity, even when adjusted for age, charlson index, EF and E/e’ (p=0.002).
Conclusions: RV function is a strong driver of outcomes in patients with preserved ejection fraction. Quantitative (TAPSE and Tei index) rather than qualitative evaluation is the key to stratify these patients. TR velocity at pulmonary valve opening time is obtainable in most patients, and adds prognostic information on top of routine hemodynamic and diastolic parameters.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-281
- 2017 American College of Cardiology Foundation