P949Prognostic value of right atrial functional parameters in chronic heart failure patients with preserved systolic function


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Abstract

Prognostic value of right atrial(RA) functional parameters in chronic heart failure (CHF) patients (pts) with preservedleft ventricular (LV) ejection fraction (PEF) has not been evaluated.The aim of studywas to assess the significance of RA functional parameters in prediction ofsurvival in pts with CHF and PEF.Methods: 108 pts(age 68.1±1.9) NYHA III functional class CHF in sinus rhythm were prospectivelystudied. RA dimensions, volumes, late diastolic transtricuspid (A) flow velocity (cm/sec), RA kineticenergy (RAKE), RA active emptyingfraction (EFakt,%), tricuspid annulus plane systolic excursion (TAPSE) (mm), RAfunction index (FI) and tricuspid regurgitation (TR) were obtained usingechocardiography. RAKE (kdyn/cm/sec) was calculated using the formula=1/2stroke volume x1.06xAxA, and RA FI = RA EF x RV OT –VTI/ RA ESV. TR wasquantified as a TR area/RA area ratio.Results: Duringa mean follow-up period of 37±0.7 months 34 (31.5%) pts died from cardiaccauses. These pts had more impaired RA function (p<0.01 for all), depictedby RA FI (18.1±0.0 vs. 27.2±0.4), RAKE (7.1±0.7 vs. 11.1±1.3), RA EFakt (14.5±1.1vs. 20.9±2.0). TAPSE (6.8±0.6 vs. 10.4 ±1.0) and TR (0.31±0.05 vs. 0.18±0.03) alsowere markedly worse (p<0.01) in non-survivors than in survivors. In died ptsrevealed more severe RV diastolic dysfunction with A (51.4±5.2 vs. 70.5±6.8,p<0.05). Multivariate stepwise Cox analysis revealed that independentpredictors of cardiac death were RA FI, TAPSE, RAKE, RA EFakt and TR. Kaplan-Meiersurvival curves demonstrated a survival rate of 84% for pts with RA FI >25and 67% for those with RAFI<25 (p<0.01). Similar probability of survival(p<0.01) was shown in pts with RAKE > 8.0 (84%), RA EFakt >17.0 (83%),TAPSE >8.0 (86%) and TR <0.25 (84%) and in those with RAKE <8.0(63.5%), RA EFakt <17.0 (64%), TAPSE < 8.0 (62%) and TR >0.25 (65%). AUCofROC were 0.85 for RA FI, 0.86 for RAKE, 0.84 for RAEFakt, 0.87 for TAPSE and 0.85 for TR as predictors of death with log rank of11.6, 11.9, 11.2, 11.5 and 10.9 (p<0.01), respectively, in Kaplan-Meieranalysis.In conclusion,RA functional parameters are the powerful predictors of survival in pts withCHF and PEF and could be effectively used in prognostic evaluation of such pts.

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