Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure

Objectives. We sought to study the relationship between survival and right ventricular ejection fraction (RVEF) in subgroup of patients with moderate congestive heart failure (CHF). Background. It has been demonstrated that RVEF is an independent predictor of survival in patients with advanced CHF. Methods. Cardiopulmonary exercise testing and radionuclide angiography (to determine right and left ventricular ejection fraction) were prospectively performed in 205 consecutive patients with moderate CHF (140 patients in New York Heart Association [NYHA] class II, 65 in class III). Results. Left ventricular ejection fraction was 29.3% ± 10.1%, RVEF was 37.5% ± 14.6% and peak oxygen consumption (VO2) was 16.2 ± 5.4 ml/min/kg (60.2% ± 19% of maximal predicted VO2). After median follow-up period of 755 days, there were 44 cardiac-related deaths, 3 deaths from noncardiac causes and 15 transplantations of whom 2 were urgent; 1 patient was lost to follow-up. Multivariate analysis showed that three variables—NYH classification, percent of maximal predicted VO2 and RVEF—were independent predictors of both survival and event-free cardiac survival. Left ventricular ejection fraction and peak VO2 normalized to body weight had no predictive value. The event-free survival rates from cardiovascular mortality and urgent transplantation at 1 year were 80%, 90% and 95% in patients with an RVEF <25%, with RVEF ≥25% and <35% and with RVEF ≥35%, respectively. At 2 years, survival rates were 59%, 77% and 93% in the same subgroups, respectively. Conclusions. In addition to the NYH classification and to the percent of maximal predicted VO2, RVEF is an independent predictor of survival in patients with moderate CHF.