Right ventricular dysfunction is a major predictor of outcome in patients with moderate to severe mitral regurgitation and left ventricular dysfunction

Abstract

Background: This study aimed to assess the prognostic value of right ventricular (RV) dysfunction in patients with secondary mitral regurgitation (MR) by simple methods of echocardiographic measurement. Although both RV dysfunction and functional MR may affect prognosis of patients with heart failure (HF) due to left ventricular (LV) dysfunction, information is lacking regarding the impact of RV dysfunction in patients with functional MR.

Methods: Among 356 consecutive patients with chronic HF due to LV dysfunction (ejection fraction < or = 45%), 107 met the entry criteria of moderate to severe MR as assessed by a vena contracta width > or = 0.5 cm. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function. Median follow-up duration was 21 months.

Results: Among patients with a vena contracta width > or = 0.5 cm, 30 (28%) died and 28 (26%) were hospitalized for worsening HF. By multivariate analysis, TAPSE < or = 14 mm (hazard ratio [HR] 2.83, P = .027) and LV ejection fraction (HR 2.17, P = .099) were predictive of death from all causes. Independent predictors of freedom from all-cause mortality or hospitalization for worsening HF were New York Heart Association class (HR 2.15, P = .027), age (HR 1.98, P = .021) and TAPSE < or = 14 mm (HR 1.96, P = .031). At 24 months, survival was 45% in those with the worse TAPSE, whereas it was 82% in those with TAPSE > 14 mm (log-rank statistic = 0.0002). Aminoterminal pro-type B natriuretic peptide plasma levels were higher in patients with vena contracta width of > or = 0.5 cm and TAPSE < or = 14 mm.

Conclusions: This study shows that RV function, assessed by TAPSE, plays a major role in the outcome of patients with functional moderate to severe MR.