Echocardiographic Grading of Right Ventricular Afterload in Left Heart Disease: Relation to Right Ventricular Function, Pulsatile and Resistant Load, and Outcome

ABSTRACT The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance. The aims of the present study on patients with left heart disease, were to evaluate a novel echocardiographic right ventricular (RV) afterload score and to investigate its relation to risk of mortality or implantation of a left ventricular assist device. Patients (n = 220) with left ventricular ejection fraction 3 Wood units (WU). One point was allocated for sPAPDoppler 36–59 mmHg and for pressure reflection variables above the upper normal limit. Low afterload was defined as 0‐to‐1 points, intermediate as 2‐to‐4 points, and high as 5‐to‐8 points. There were in‐between the groups significant differences in PAC and PVR. A 5‐point RV dysfunction score showed with stepwise increased RV afterload more severe dysfunction. Unadjusted hazard ratio for endpoint was 3.34 (1.69–6.79) for intermediate score, and 5.11 (2.52–10.40) for patients with high score. In conclusion, in patients with severe heart failure, a novel echocardiographic RV afterload score is related to increased pulsatile and resistant load, more severe RV dysfunction, and increased risk of adverse outcome.