Journal of the Indian Academy of Echocardiography & Cardiovascular Imaging (Jan 2019)
Prognostic Significance of Right Ventricular Ejection Fraction Assessed by Two-Dimensional Echocardiography in Hospitalized Patients with Dilated Cardiomyopathy
Abstract
Background: The aim of this study was to evaluate the prognostic significance of two-dimensional transthoracic echocardiography right ventricle ejection fraction (2D-TTE-RV-EF) calculated using 2D-TTE and compare the results with conventional RV function parameters such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RV-FAC) in hospitalized dilated cardiomyopathy (DCMP) patients. Methods: This is a prospective, observational study that includes 122 DCMP patients. RV was modeled as a part of an ellipsoid enabling calculation of RV volume by combining three echo measurements. RVEF is then calculated (2D-TTE-RV-EF). P < 0.05 is considered statistically significant, and multivariate logistic regression analysis was done to determine the predictors of inhospital outcomes. Results: The mean age of study population was 51.2 ± 9.2 years with male: female ratio of 1.8:1. Mean value of LV-EF (Simpson biplane model) and 2D-TTE-RV-EF (ellipsoid model) was 33.6% ± 7.1% and 38.1% ± 11.2%, respectively. About 41 (33.6%) patients experienced inhospital major adverse cardiac events (MACE). In multivariate regression analysis, New York Heart Association class III or IV status, reduced LV-EF, reduced 2D-TTE-RV-EF, and cardiogenic shock at presentation were found to be independent predictors of in MACE. Analysis of receiver operator characteristic curve demonstrated that the optimal cutoff value of 2D-TTE-RV-EF for predicting inhospital MACE was 32.8%. Conclusion: Quantitative assessment of RV function with 2D-TTE-RV-EF improves the risk stratification beyond provided by LV-EF; the prognostic value may be better than that provided by TAPSE and RV-FAC.
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