Right Ventricular Function Score by Echocardiography for Predicting Outcomes After Heart Transplantation

The impaired right ventricular (RV) function may occur after heart transplantation (HT). This study aimed to develop a straightforward RV function score (RVFS) using echocardiography to predict adverse clinical events in a large cohort of subjects after HT.

A total of 357 consecutive patients post HT who underwent echocardiography at our single institution were retrospectively included. RV systolic function was evaluated by echocardiography. A multivariate Cox regression analysis was performed to identify the independent predictors of RV function for adverse clinical events.

During a median follow-up of 39 months from the date of the echocardiography, a composite of adverse events that included death and major adverse cardiac events occurred in 51 patients. The multivariate Cox analysis revealed that RV fractional area change, tricuspid annular plane systolic excursion, and RV free wall longitudinal strain were independent predictors of outcomes after HT. The RVFS was constructed based on these 3 parameters, assigning a value of 1 when a predictor was below its cutoff value from receiver operating characteristic curves and 0 when above. The RVFS outperformed separate RV function parameters in predicting outcomes (area under the curves: 0.84 versus 0.64-0.78, P<0.05). Moreover, incorporating the RVFS into the base clinical model significantly improved the C-statistic of the prediction model (C-statistic from 0.70 to 0.83, P<0.001).

The RVFS, a readily obtainable echo score that combines multiple RV function parameters, exhibits incremental value and significant potential as a robust predictor for adverse outcomes in clinically stable patients after HT.