Relationship between left and right ventricular ejection fractions in chronic advanced systolic heart failure: insights from the BEST trial.

Pubmed ID: 21097899

Pubmed Central ID: PMC3063564

Journal: European journal of heart failure

Publication Date: April 1, 2011

MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Chronic Disease, Heart Failure, Stroke Volume, Cross-Sectional Studies, Ventricular Function, Left, Ventricular Function, Right

Grants: R01-HL085561, R01-HL097047

Authors: Ahmed MI, White M, Ahmed A, Meyer P, Adamopoulos C, Mujib M, Desai RV, Aban IB, Iskandrian AE

Cite As: Desai RV, Meyer P, Ahmed MI, Mujib M, Adamopoulos C, White M, Aban IB, Iskandrian AE, Ahmed A. Relationship between left and right ventricular ejection fractions in chronic advanced systolic heart failure: insights from the BEST trial. Eur J Heart Fail 2011 Apr;13(4):392-7. Epub 2010 Nov 21.

Studies:

Abstract

AIMS: Abnormally low right ventricular ejection fraction (RVEF) is a predictor of poor outcomes in chronic heart failure (HF) patients with low left ventricular ejection fraction (LVEF). However, little is known about the relationship between LVEF and RVEF in these patients. METHODS AND RESULTS: Of the 2707 Beta-blocker Evaluation of Survival Trial (BEST) participants with ambulatory chronic HF, New York Heart Association class III-IV symptoms, and LVEF ≤ 35%, 2008 patients had gated-equilibrium radionuclide angiographic data on baseline LVEF and RVEF. Patients were categorized into quartiles by LVEF ≥ 29% (n = 507), 23-28% (n = 513), 17-22% (n = 538), and < 17% (n = 450). Logistic regression models were used to determine the association of LVEF quartiles (reference, ≥ 29%) with abnormally low RVEF (<20%). The prevalence of RVEF < 20% for patients with LVEF quartiles ≥ 29, 23-28, 17-22, and < 17% were 3, 6, 15, and 32%, respectively. Unadjusted odds ratios [95% confidence intervals (CIs)] for RVEF < 20% (vs. ≥ 20%) associated with LVEF quartiles 23-28, 17-22, and < 17% (reference, ≥ 29%) were 2.18 (1.14-4.17; P = 0.018), 6.32 (3.54-11.30; P < 0.001), and 16.67 (9.46-29.39; P < 0.001), respectively. Respective multivariable-adjusted odds ratios (95% CIs) were 1.82 (0.94-3.54; P = 0.076), 4.55 (2.48-8.35; P < 0.001), and 10.53 (5.70-19.44; P< 0.001), respectively. Heart failure symptoms and signs had unadjusted associations with low RVEF, but lacked intrinsic associations. CONCLUSION: In patients with advanced systolic HF, LVEF has a strong dose-dependent relationship with RVEF which is independent of other characteristics, and low LVEF is useful as a surrogate marker of abnormally low RVEF in these patients.