Open Access Research

Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction

Masashi Yamaguchi1, Toshihiro Tsuruda1*, Yuki Watanabe2, Hisamitsu Onitsuka1, Kuniko Furukawa3, Takeshi Ideguchi1, Junji Kawagoe1, Tetsunori Ishikawa1, Johji Kato4, Makoto Takenaga2 and Kazuo Kitamura1

Author Affiliations

1 Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki 889-1692, Japan

2 Internal Medicine, Fujimoto Central Hospital, 3584-1 Midarebashi Kitakawauchi, Miyazaki 880-0941, Japan

3 Clinical laboratory, Miyazaki University Hospital, 5200 Kihara Kiyotake, Miyazaki 889-1692, Japan

4 Frontier Science Research Center, University of Miyazaki, 5200 Kihara Kiyotake, Miyazaki 889-1692, Japan

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Cardiovascular Ultrasound 2013, 11:19  doi:10.1186/1476-7120-11-19

Published: 3 June 2013

Abstract

Background

Recent studies suggest the significance of right ventricular (RV) function in the outcome in patients with left ventricular dysfunction (LVSD); however, global assessment of RV remains to be determined by echocardiogram because of its complex geometry. This study aimed to validate RV outflow tract fractional shortening (RVOT-FS) in the evaluation of RV function and its prognostic value in patients with LVSD.

Methods

This study included eighty-one patients (62 ± 17 years, mean ± SD, male 79%) with reduced LV ejection fraction (LVEF) (≤40%). Two-dimensional echocardiogram of the parasternal short axis view was obtained at the level of the aortic root, and RVOT-FS was calculated as the ratio of end-diastole minus end-systole dimension to end-diastole dimension.

Results

RVOT-FS ranged from 0.04 to 0.8 (0.3 ± 0.2, mean ± SD), and correlated with LVEF (r = 0.33, p = 0.0028), RV fractional area change (r = 0.37, p = 0.0008) and brain natriuretic peptide level (r = -0.38, p = 0.0005). In Cox multivariate regression analysis, RVOT-FS [hazard ratio (HR) 0.028, 95% confidence interval (CI): 0.002-0.397]; p = 0.008] and New York Heart Association functional class III-IV [HR 2.233, 95% CI: 1.048-4.761]; p = 0.037] were independent factors to predict the events. During a median follow-up period of 319 days (1 to 1862 days), patients with RVOT-FS ≥ 0.2 showed a higher event-free rate than those < 0.2 by Kaplan-Meier analysis (log-rank test, p = 0.0016).

Conclusions

Our data suggest that RVOT-FS is a simple parameter reflecting the severity of both ventricular function in patients with LVSD. In addition, RVOT-FS might be useful to predict adverse outcomes in such a patient population.

Keywords:
Heart failure; Right ventricle; Brain natriuretic peptide