Internal and Emergency Medicine

, Volume 14, Issue 7, pp 1091–1100 | Cite as

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction

  • Gaspare ParrinelloEmail author
  • Daniele Torres
  • Silvio Buscemi
  • Tiziana Di Chiara
  • Francesco Cuttitta
  • Mauro Cardillo
  • Francesca Romana Pluchinotta
  • Rosario Scaglione
  • Salvatore Paterna
  • Antonio Pinto


Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (< 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2.4, p = 0.04; HR 1.06, p = 0.02; HR 1.02, p = 0.01), whereas, left atrial volume (LAV) was significantly associated with mortality in HFrEF (HR 1.06, p = 0.006). Excluding LAV from the model, only COPD remained an independent predictor of all-cause mortality (HR 2.15, p = 0.04) in HFrEF. At Kaplan–Meier analysis, no differences of survival between HFrEF and HFpEF were found, however, significantly increased all-cause mortality for higher values of basal-RVd, BUN, and IVCd (log-rank p = 0.0065, 0.0063, 0.0005) in HFpEF, and for COPD and higher LAV (log-rank p = 0.0046, p = 0.033) in HFrEF. These data are indicative that in patients hospitalized with HF, EF is not a suitable predictor of long-term all-cause mortality, whereas, right ventricular volumetric remodeling and IVCd have a prognostic role in HFpEF as well as LAV in HFrEF. Our study suggests that besides EF, other echocardiographic parameters are helpful to optimize the phenotyping and prognostic stratification of HF.


Heart failure Ejection fraction Cardiac remodeling Right ventricular diameter Mortality 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement on human and animal rights

The study was performed in accordance with the principles of Declaration of Helsinki and its appendices, and with local and national laws. Approval was obtained from the Hospital’s Institutional Review Board and Ethics Committee (A.O.U.P. Paolo Giaccone).

Informed consent

For this study, formal consent was not required.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Gaspare Parrinello
    • 1
    Email author
  • Daniele Torres
    • 1
  • Silvio Buscemi
    • 1
  • Tiziana Di Chiara
    • 1
  • Francesco Cuttitta
    • 1
  • Mauro Cardillo
    • 1
  • Francesca Romana Pluchinotta
    • 2
  • Rosario Scaglione
    • 1
  • Salvatore Paterna
    • 1
  • Antonio Pinto
    • 1
  1. 1.Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities“G. D’Alessandro” – PROMISE, - A.O.U.P. “Paolo Giaccone”, University of PalermoPalermoItaly
  2. 2.Department of Paediatric Cardiac SurgeryIRCCS Policlinico San Donato MilaneseMilanItaly

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