Incremental Prognostic Value of Echocardiography Measures of Right Ventricular Systolic Function in Patients With Chronic Heart Failure

Background Tricuspid annular plane systolic excursion (TAPSE), Doppler tissue imaging–derived tricuspid lateral annular systolic wave velocity (S′), and right ventricular fractional area change (RV‐FAC) are the most widely used echocardiographic measures of right ventricular systolic function. This study aimed to compare the prognostic value of TAPSE, S′, and RV‐FAC in a large cohort of patients with chronic heart failure. Methods Consecutive outpatients with heart failure and left ventricular ejection fraction <50% on guideline‐recommended therapies undergoing echocardiography were followed up for the end point of cardiac and all‐cause death. Results Among 1590 patients (71±12 years, 77% men, left ventricular ejection fraction 34%±9%), 202 (13%) died from cardiac causes during a median follow‐up of 28 (interquartile range, 14–40) months. According to the recommended cut points for TAPSE (<17 mm), S′ (<9.5 cm/s), or RV‐FAC (<35%), right ventricular systolic dysfunction was found in 37%, 40%, and 35% of patients, respectively, with 21%, 31%, and 33% of discordant cases comparing TAPSE versus S′, TAPSE versus RV‐FAC, and S′ versus RV‐FAC. Both TAPSE <17 mm and RV‐FAC <35% were more accurate than S′ <9.5 cm/s in predicting the risk of cardiac death ( P <0.001), and their combination showed incremental prognostic power ( P <0.001). Adding S′ to the combination of TAPSE and RV‐FAC did not provide further incremental value ( P =0.145). Similar findings were obtained when all‐cause death was considered as the end point. Conclusions In patients with chronic heart failure and left ventricular ejection fraction <50%, TAPSE, and RV‐FAC are more accurate than S′ in predicting the risk of cardiac and all‐cause death. Considering both RV‐FAC and TAPSE provides incremental prognostic value.