Moderated Posters session V: How to assess right ventricular function? * Saturday 11 December 2010, 10:00-11:00

The aim of study was to assess the usefulness left (LV) ang right ventricular (RV) diastolic dysfuncion in the prediction of mortality in CHF pts with preserved LV ejection fraction (EF). Methods: 106 pts (age 63.1+0.9) with NYHA III class diastolic CHF in sinus rhythm were prospectively studied. LV EF (%), LV and RV mass index (MI), LA and RA volume index (VI), transmitral and transtricuspid peak early (Em and Et) and late (Am and At) filling velocities (m/sec), Em/Am and Et/At ratios, the deceleration time (DT) of Em and ET waves, the Am and AT wave duration (Am and At dur), pulmonary venous atrial reversal peak flow velocity (Ard), duration of reversed pulmonary vein atrial systole flow (AR), relation of pulmonary vein systolic (S) and diastolic (D) flow velocities (S/D), pulmonary valve flow acceleration time (PAat), pre-ejection period (PEP) and ejection time (PAet) at the RV outflow were obtained using echocardiography. Results: According to ratio of transmitral peak early (E) and late (A) filling velocities (E/ A) and the deceleration time (DT, msec) of E-wave, pts, receiving standard CHF treatment, were randomly assigned to groups with restrictive (RFP) [E/A.1.5, DT,140, 36 pts], pseudonormal (PFT) [0.75 E/A ,1.5, 140 DT ,240, 36 pts) and abnormal relaxation filling pattern (ARFP) [E/A,0.75, DT.240, 38 pts] and were followed for 37+0.7 months. Pts with CHF and preserved systolic function have high mortality (36.8%), hospitalization (57.5%) and mortality or hospitalization (74.5%) rates. Survivors had lower Em/ Am (0.8+0.2 vs. 2.3+0.3), PAet (190+15 vs. 260+18), pulmonary vein S/D relation (0.45+0.1 vs 0.85+0.11), higher Et/At (1.25+0.08 vs. 0.84+0.07), Ard-Ad (50+2.1 vs. 43+1.3), longer DTm (240+12 vs. 120+7.7) and shorter DTt (139.2+9.1 vs.196.9+12.1) than died pts, (p,0.01 for all). Multivariate Cox stepwise analysis revealed that Em/Am, Et/At, S/D, Ard-Ad, PAet, DTm and DTt were the significant independent predictors of cardiac death. The 3-year mortality (47.1% vs. 27.8%), hospitalization rate (76.5% vs. 41.7%) and combined endpoint of mortality or hospitalization (94.1% vs. 58.3%) were significantly (p,0.05) higher in pts with RFP than with ARFP. Pts with PFP represented the intermediate risk group with mortality, hospitalization rate and combined endpoint of mortality or hospitalization of 36.1%, 55.6% and 72.2%, respectively (p,0.05). In conclusions, parameters of LV and RV diastolic dysfunction are the powerful independent predictors of survival in pts with CHF and preserved systolic function.