Right Ventricular Function and Prognosis in Stable Heart Failure Patients

Background: Right ventricular ejection fraction (RVEF) is a mortality predictor in heart failure (HF) patients. There are controversial results regarding the influence of RVEF on other important prognostic variables. The purpose of this study was to investigate the effect of RVEF on exercise parameters obtained during cardiopulmonary exercise testing (CPET), creatinine and B-type natriuretic peptide (BNP) levels, and a composite outcome of death, heart transplantation, or ventricular assist device implantation in ambulatory HF patients. Methods and Results: This retrospective cohort study included 246 ambulatory HF patients with CPET and RVEF evaluated with the use of first-pass radionuclide angiography. We analyzed the impact of RVEF on other prognostic factors with the use of multivariable linear regression. The mean age was 49 +/- 12 years. The mean peak VO2 was 16.4 +/- 5.7 mL kg(-1) min(-1), mean peak VE/VCO2 34.1 +/- 9.1, mean creatinine 1.17 +/- 0.40 mg/dL, and median BNP 158 pg/mL (interquartile range 374 pg/mL). The mean left ventricular ejection fraction was 35 +/- 12% and the mean RVEF 38 +/- 10%. For every 10% decrease in RVEF, peak VO2 decreased 0.97 mL kg(-1) min(-1) (P < .05), creatinine increased 0.12 mg/dL (P < .01), and log BNP increased 0.26 (P < .05). Conclusions: We found an independent association between RVEF and prognostic markers in HP patients. Worsening RV function may exert its negative effect on prognosis through increasing congestion (elevated BNP), affecting renal blood flow (increased creatinine) and limiting left ventricular preload, thereby reducing exercise tolerance.