THE VALUE OF RIGHT VENTRICULAR EJECTION FRACTION AS A PROGNOSTIC FACTOR IN MODERATE-SEVERE SYSTOLIC CARDIAC FAILURE
A. Aggarwal*, H.P. Brunner-La Rocca, P. Bergin, M. Esler, D. Kaye.
B. Cardiology Department, Alfred Hospital, Melbourne, Victoria.
A reduced right ventricular ejection fraction (RVEF) has been reported to highly correlate with risk of early death in patients with moderate to severe congestive heart failure (CHF). It has thus been suggested that those patients on the waiting list for cardiac transplantation with significantly reduced RVEF should receive priority. We report our experience of 96 patients with moderate to severe CHF who were referred for cardiac transplant assessment. These patients underwent right heart catheterisation with measures of cardiac sympathetic activity using the isotope dilution method, and radionuclide ventriculography. The mean left ventricular ejection fraction (LVEF) was 20.5±7.8% and the mean RVEF was 43.8±14.4%. The mean follow-up period was 587±560 days. The one and two-year survival rates were 86% and 79% respectively.
LVEF was not strongly correlated with RVEF. RVEF did not predict either death of combined events (death or transplantation). There was a trend towards low RVEF and early cardiac death, but this did not reach statistical significance (p=0.08, figure). RVEF correlated (r = -0.6) with the mean pulmonary capillary wedge pressure, a predictor of prognosis in our patients. When this pressure was factored into the analysis, the above trend disappeared. Markers of sympathetic overactivity were strong prognostic factors.
In conclusion, we did not find RVEF to be a useful prognostic factor in this group of patients with moderate to severe heart failure. The RVEF appeared to be a reflection of the filling pressures of the left heart.
