Author/Editor		Meyer, Philippe; Desai, Ravi V; Mujib, Marjan; Feller, Margaret A; Adamopoulos, Chris; Banach, Maciej; Lainščak, Mitja; Aban, Inmaculanda; White, Michel; Aronow, Wilbert S
Title		Right ventricular ejection fraction <20% is an independent predictor of mortality but not of hospitalization in older systolic heart failure patients
Type		članek
Source		Int J Cardiol
Vol. and No.		Letnik 155, št. 1
Publication year		2012
Volume		str. 120-5
Language		eng
Abstract		Background: Reduced right ventricular ejection fraction (RVEF) is associated with poor outcomes in patients with chronic systolic heart failure (HF). Although most HF patients are older adults, little is known about the relationship between low RVEF and outcomes in older adults with systolic HF. Methods: Of the 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with systolic HF (left ventricular ejection fraction </=35%) 822 were >/=65years and had data on baseline RVEF estimated by gated-equilibrium radionuclide ventriculography. Using RVEF >/=40% (n=308) as reference, we examined association of RVEF 30-39% (n=214), 20-29% (n=206) and <20% (n=94) with outcomes using Cox regression models. Results: All-cause mortality occurred in 36%, 40%, 39% and 56% of patients with RVEF >/=40%, 30-39%, 20-29% and <20% respectively. Compared with RVEF >/=40%, unadjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality associated with RVEF 30-39%, 20-29% and <20% were 1.19 (0.90-1.57; P=0.220), 1.13 (0.84-1.51; P=0.423) and 1.97 (1.43-2.73; P<0.001) respectively. Respective multivariable-adjusted HR's (95% CI's) for all-cause mortality were 1.19 (0.88-1.60; P=0.261), 1.00 (0.73-1.39; P=0.982) and 1.70 (1.14-2.53; P=0.009). Adjusted HR's (95% CI's) associated with RVEF <20% (versus >/=40%) for cardiovascular mortality and HF mortality were 1.79 (1.17-2.76; P=0.008) and 1.97 (1.02-3.83; P=0.045) respectively. RVEF had no independent association with sudden cardiac death, all-cause or HF hospitalization. Conclusions: Abnormally low RVEF is a significant independent predictor of mortality, but not of HF hospitalization, in older adults with systolic HF.
Descriptors		HEART FAILURE, CONGESTIVE ADRENERGIC BETA-ANTAGONISTS SYSTOLE STROKE VOLUME RADIONUCLIDE VENTRICULOGRAPHY TREATMENT OUTCOME SURVIVAL ANALYSIS CAUSE OF DEATH