• right ventricle
• heart failure, prognosis

• CHF, congestive heart failure
• DCM, dilated cardiomyopathy
• DVI, diastolic ventricular interaction
• IHD, ischaemic heart disease
• LVEDP, left ventricular end diastolic pressure
• LVEF, left ventricular ejection fraction
• RVEDP, right ventricular end diastolic pressure
• RVEF, right ventricular ejection fraction
• V̇ o ₂
• oxygen consumption

When considering the entire range of left ventricular ejection fractions (LVEF) after a myocardial infarction, this parameter is a powerful predictor of mortality.¹ However extended follow up studies have shown that prolonged survival occurs in some patients with congestive heart failure (CHF) who have adverse conventional prognostic markers, including very low LVEF.² In patients with LVEF < 20%, the absolute value has little prognostic significance but peak oxygen consumption (peak V̇o₂) is predictive. There is increasing evidence that right ventricular ejection fraction (RVEF) is also a powerful predictor of mortality in this subgroup of patients—perhaps the most powerful predictor.

In patients with CHF caused by dilated cardiomyopathy (DCM), reduced RVEF assessed using gated heart pool scanning (< 38%) has been shown to be associated with increased mortality in patients with LVEF < 30% but not in those patients with higher LVEFs.¹ Similarly, in patients with ischaemic heart disease (IHD), RVEF is prognostically important in those patients with LVEF < 40%.³ In a study undertaken in a cardiac transplant waiting list population (of mixed aetiology), patients were stratified according to RVEF greater or less than 24%. RVEF was shown to be an independent …