Prognostic importance of right ventricular dysfunction

Although left ventricular ejection fraction is a powerful predictor of mortality following a myocardial infarction, in certain situations right ventricular ejection fraction may provide additional prognostic information When considering the entire range of left ventricular ejection fractions (LVEF) after a myocardial infarction, this parameter is a powerful predictor of mortality.1 However extended follow up studies have shown that prolonged survival occurs in some patients with congestive heart failure (CHF) who have adverse conventional prognostic markers, including very low LVEF.2 In patients with LVEF < 20%, the absolute value has little prognostic significance but peak oxygen consumption (peak Vo2) is predictive. There is increasing evidence that right ventricular ejection fraction (RVEF) is also a powerful predictor of mortality in this subgroup of patients—perhaps the most powerful predictor. In patients with CHF caused by dilated cardiomyopathy (DCM), reduced RVEF assessed using gated heart pool scanning (< 38%) has been shown to be associated with increased mortality in patients with LVEF < 30% but not in those patients with higher LVEFs.1 Similarly, in patients with ischaemic heart disease (IHD), RVEF is prognostically important in those patients with LVEF < 40%.3 In a study undertaken in a cardiac transplant waiting list population (of mixed aetiology), patients were stratified according to RVEF greater or less than 24%. RVEF was shown to be an independent …