Right Ventricular Function and Its Association With Outcomes in Advanced Heart Failure.

OBJECTIVE

To describe the clinical correlates of right ventricular function in advanced/stage D heart failure and its association with risks of death and hospitalizations in this population.

METHODS

This retrospective cohort study included adult residents of Olmsted County, Minnesota, with advanced heart failure between 2007 and 2018. Patients were classified by right ventricular function assessed by echocardiography at the time of advanced heart failure. The association of right ventricular function with risks of death and hospitalizations through June 30, 2023, was examined by Cox and Andersen-Gill models, respectively.

RESULTS

There were 925 patients included in the analysis (mean age, 77.2 years; 44.5% women). Right ventricular function was normal in 29% (n=266), mildly reduced in 38% (n=349), and moderately to severely reduced in 33% (n=310). Percentage with preserved left ventricular ejection fraction was 60.2%, 41.3%, and 31.0% in patients with normal right ventricular function, mild right ventricular dysfunction, and moderate to severe right ventricular dysfunction, respectively (P<.001). Compared with patients with normal right ventricular function, moderate to severe right ventricular dysfunction was associated with increased risks of mortality: all-cause (adjusted hazard ratio, 1.30; 95% CI, 1.09 to 1.55) and cardiovascular (adjusted hazard ratio, 1.32; 95% CI, 1.06 to 1.66). There was no significant difference in all-cause or heart failure-specific hospitalization risk by right ventricular function.

CONCLUSION

Right ventricular dysfunction was present in 71% patients with advanced heart failure and increased with decreasing left ventricular ejection fraction. Moderate to severe right ventricular dysfunction was associated with increased all-cause and cardiovascular death but had no association with hospitalizations.