We sought to study the relationship between survival and right ventricular ejection
fraction (RVEF) in a subgroup of patients with moderate congestive heart failure (CHF).
It has been demonstrated that RVEF is an independent predictor of survival in patients
with advanced CHF.
Cardiopulmonary exercise testing and radionuclide angiography (to determine right
and left ventricular ejection fraction) were prospectively performed in 205 consecutive
patients with moderate CHF (140 patients in New York Heart Association [NYHA] class
II, 65 in class III).
Left ventricular ejection fraction was 29.3%+/-10.1%, RVEF was 37.5%+/-14.6% and peak
oxygen consumption (VO2) was 16.2+/-5.4 ml/min/kg (60.2%+/-19% of maximal predicted
VO2). After a median follow-up period of 755 days, there were 44 cardiac-related deaths,
3 deaths from noncardiac causes and 15 transplantations of whom 2 were urgent; 1 patient
was lost to follow-up. Multivariate analysis showed that three variables-NYHA classification,
percent of maximal predicted VO2 and RVEF-were independent predictors of both survival
and event-free cardiac survival. Left ventricular ejection fraction and peak VO2 normalized
to body weight had no predictive value. The event-free survival rates from cardiovascular
mortality and urgent transplantation at 1 year were 80%, 90% and 95% in patients with
an RVEF <25%, with a RVEF > or =25% and <35% and with a RVEF > or =35%, respectively.
At 2 years, survival rates were 59%, 77% and 93% in the same subgroups, respectively.
In addition to the NYHA classification and to the percent of maximal predicted VO2,
RVEF is an independent predictor of survival in patients with moderate CHF.