Predictors of right ventricular dysfunction development 12 months after myocardial revascularization in patients with ischemic heart failure
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.03Keywords:
right ventricular dysfunction, myocardial revascularization, ischemic heart failure, prognosisAbstract
Introduction. Right ventricular dysfunction (RVD) is a prognostic factor for morbidity and mortality across a wide range of cardiovascular diseases. The aim of this research was to identify the predictors influencing the development of RVD in patients with ischemic heart failure (HF) 12 months after myocardial revascularization. Methods. The research was a prospective study that included 275 patients with ischemic HF, assessed at 3 and 12 months after myocardial revascularization (coronary artery bypass grafting - 54.5%, percutaneous coronary intervention- 45.5%). NT-proBNP evaluation, echocardiography and cardiopulmonary exercise testing was performed. Patients were divided into two groups based on the detection of de novo RVD at the end of the study.Results. The RVD rate was 39.2% and 49.2% in the studied cohort at 3 and 12 months post-myocardial revascularization, respectively. De novo RVD was identified in 19.9% of the study population. The prognostic factors that influenced the development of RVD during the studied period were: duration of ischemic heart disease, stage C AHA/ACC of HF, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, wall motion score, peak tricuspid regurgitation velocity, right atrial area, right ventricular outflow tract acceleration time, TAPSE/PASP ratio, pulmonary vascular resistance assessed by echocardiography and VE/VCO2 slope. Discriminant analysis enabled the development of a predictive model for de novo RVD over 12 months after myocardial revascularization, based on 4 parameters: duration of ischemic heart disease, HF stage according to the AHA/ACC classification, right atrial diameter and left ventricular end-diastolic diameter. This model allows the accurate prediction of de novo RVD in 62.2% of cases.Conclusion. The rate of de novo RVD at 12 months after myocardial revascularization was 19.9%. Key echocardiographic parameters of pulmonary hypertension and HF syndrome demonstrated a significant prognostic impact on RVD development at the end of the first year after the acute cardiac event.
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