Right ventricular response to intensive medical therapy in advanced decompensated heart failure

David Verhaert, Wilfried Mullens, Allen Borowski, Zoran B. Popović, Ronan J. Curtin, James D. Thomas, W. H Wilson Tang

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


Background: Right ventricular (RV) systolic dysfunction is a strong predictor of adverse outcomes in heart failure, yet quantitatively assessing the impact of therapy on this condition is difficult. Our objective was to compare the clinical significance of changes in RV echocardiographic indices in response to intensive medical treatment in patients admitted to the hospital with acute decompensated heart failure (ADHF). Methods and Results: Serial comprehensive echocardiography was performed in 62 consecutive patients with ADHF, and adverse events (death, cardiac transplantation, assist device, heart failure rehospitalization) were prospectively documented. RV peak systolic strain was assessed using speckle-tracking longitudinal strain analysis as the average of the basal, mid-, and apical segment of the RV free wall. Other conventional parameters of RV function (RV fractional area change, RV myocardial performance index, tricuspid annular peak systolic excursion, and tissue Doppler peak tricuspid annular systolic velocity) were measured for comparison. In our study cohort [left ventricular ejection fraction, 26 ±10%; cardiac index, 2.0±0.6 L/(min m2)], overall mean RV peak systolic strain was -14±4% at baseline and -15±4% at 48 to 72 hours (P=0.27). Among all the RV functional indices measured, only RV peak systolic strain at 48 to 72 hours was associated with adverse events (P=0.02). In particular, improvement in RV peak systolic strain after intensive medical treatment was associated with lower adverse events in this patient population (26% versus 78%; hazard ratio, 0.13; 95% CI, 0.02 to 0.84; P=0.02). Conclusion: Dynamic improvement in RV mechanics in response to intensive medical therapy was associated with lower long-term adverse events in patients with ADHF than in patients not showing improvement.

Original languageEnglish (US)
Pages (from-to)340-346
Number of pages7
JournalCirculation: Heart Failure
Issue number3
StatePublished - May 2010


  • Echocardiography
  • Heart failure
  • Hemodynamics
  • Prognosis
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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