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      Added predictive value of right ventricular ejection fraction compared with conventional echocardiographic measurements in patients who underwent diverse cardiovascular procedures

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          Background and aim

          Right ventricular (RV) ejection fraction (EF) assessed by 3D echocardiography is a powerful measure to detect RV dysfunction. However, its prognostic value in routine clinical practice has been scarcely explored. Accordingly, we aimed at investigating whether RVEF is associated with 2-year all-cause mortality in patients who underwent diverse cardiovascular procedures and to test whether RVEF can overcome conventional echocardiographic parameters in terms of outcome prediction.

          Patients and methods

          One hundred and seventy-four patients were retrospectively identified who underwent clinically indicated transthoracic echocardiography comprising 3D acquisitions. The patient population consisted of heart failure with reduced ejection fraction patients (44%), heart transplanted patients (16%), and severe valvular heart disease patients (39%). Beyond conventional echocardiographic measurements, RVEF was quantified by 3D echocardiography. The primary endpoint of our study was all-cause mortality at two years.


          Twenty-four patients (14%) met the primary endpoint. Patients with adverse outcomes had significantly lower RVEF (alive vs. dead; 48 ± 9 vs. 42 ± 9%, P < 0.01). However, tricuspid annular plane systolic excursion (21 ± 7 vs. 18 ± 4 mm), and RV systolic pressure (36 ± 15 vs. 39 ± 15 mmHg) were similar. By Cox analysis, RVEF was found to be associated with adverse outcomes (HR [95% CI]: 0.945 [0.908–0.984], P < 0.01). By receiver-operator characteristic analysis, RVEF exhibited the highest AUC value compared with the other RV functional measures (0.679; 95% CI: 0.566–0.791).


          Conventional echocardiographic measurements may be inadequate to support a granular risk stratification in patients who underwent different cardiac procedures. RVEF may be a robust clinical parameter, which is significantly associated with adverse outcomes.

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          Author and article information

          Akadémiai Kiadó (Budapest )
          20 December 2021
          10 June 2021
          : 13
          : 2
          : 130-137
          [1 ] Heart and Vascular Center, Semmelweis University , Budapest, Hungary
          [2 ] Clinic of Cardiology, University and Clinical Center of Kosovo , Prishtina, Kosovo
          Author notes
          [* ]Corresponding author. Heart and Vascular Center, Semmelweis University , Városmajor str. 68, Budapest, H-1122, Hungary. Tel.: +36 206663427. E-mail: attila.kovacs@ 123456med.semmelweis-univ.hu
          © 2021 The Author(s)

          Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated. (SID_1)

          Page count
          Figures: 3, Tables: 3, Equations: 0, References: 18, Pages: 08
          Funded by: National Research, Development, and Innovation Office of Hungary
          Award ID: NVKP_16-1-2016-0017
          Funded by: New National Excellence Program
          Award ID: ÚNKP-20-3-II-SE-54
          Award ID: ÚNKP-20-4-II-SE-20
          Funded by: Artificial Intelligence National Laboratory Program
          Funded by: Thematic Excellence Program
          Award ID: 2020-4.1.1.-TKP2020
          Custom metadata

          Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
          ejection fraction,3D echocardiography,right ventricle,mortality


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