Effects of Right Ventricular Ejection Fraction on Outcomes in Chronic Systolic Heart Failure

Abstract

Background— Studies of the effect of right ventricular ejection fraction (RVEF) on outcomes in heart failure (HF) are limited by small sample size and short follow-up. Methods and Results— We examined the effect of baseline RVEF on outcomes in 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with HF and left ventricular ejection fraction ≤35% during 24 months of mean follow-up. RVEF, estimated by gated-equilibrium radionuclide ventriculography, was used to categorize patients into 4 RVEF groups: ≥40% (n=733), 30% to 39% (n=531), 20% to 29% (n=473), and <20% (n=271). Unadjusted rates for all-cause mortality in patients with RVEF ≥40%, 30% to 39%, 20% to 29%, and <20% were 27%, 32%, 35%, and 47%, respectively. When compared with patients with RVEF ≥40%, unadjusted hazard ratios and 95% confidence intervals for all-cause mortality for those with RVEF 30% to 39%, 20% to 29%, and <20% were 1.19 (0.97 to 1.46; P =0.087), 1.45 (1.17 to 1.78; P =0.001), and 1.98 (1.59 to 2.47; P <0.0001), respectively. Respective multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause mortality associated with RVEF 30% to 39%, 20% to 29%, and <20% were 1.07 (0.87 to 1.32; P =0.518), 1.12 (0.89 to 1.40; P =0.328), and 1.32 (1.02 to 1.71; P =0.034), respectively. Adjusted hazard ratios (95% confidence intervals) for other outcomes associated with RVEF <20% (compared with ≥40%) were as follows: cardiovascular mortality, 1.33 (1.01 to 1.76; P =0.041); HF mortality, 1.61 (1.03 to 2.52; P =0.037); sudden cardiac death, 1.29 (0.87 to 1.91; P =0.212); all-cause hospitalization, 1.21 (1.00 to 1.47; P =0.056); and HF hospitalization, 1.39 (1.10 to 1.77; P =0.007). Conclusions— Baseline RVEF <20% is a significant independent predictor of mortality and HF hospitalization in systolic HF.