04-右心衰竭诊断治疗中国专家共识.pptVIP

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2017-06-17 发布于浙江
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04-右心衰竭诊断治疗中国专家共识.ppt

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04-右心衰竭诊断治疗中国专家共识

* * * * RVEF may be useful as both a marker and mechanism of poor prognosis in systolic HF and that the estimation of RVEF should be considered as part of a comprehensive assessment of these patients. Baseline RVEF is a significant independent predictor of mortality and HF hospitalization in systolic HF 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 LVEF35% 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), and20% (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; P0.087), 1.45 (1.17 to 1.78; P0.001), and 1.98 (1.59 to 2.47; P0.0001), 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; P0.518), 1.12 (0.89 to 1.40; P0.328), and 1.32 (1.02 to 1.71; P0.034), 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; P0.041); HF mortality, 1.61 (1.03 to 2.52; P0.037); sudden cardiac death, 1.29 (0.87 to 1.91; P0.212); all-cause hospitalization, 1.21 (1.00 to 1.47; P0.056); and HF hospitalization, 1.39 (1.10 to 1.77; P0.007). * * * Because the RV chamber is larger than the LV chamber, RVEF is, under normal conditions, lower than LV ejection fraction. The normal range of RVEF varies between 40% and 76% depending on the methodology