Results:

Patients with more advanced NYHA class were older (p = 0.008), had higher body mass index (p = 0.004), more often had pulmonary arterial hypertension (p = 0.002), and had more abnormal parameters of LV diastolic dysfunction. After a follow-up of 21.9 ± 13.1 months, 64 patients (33.2%) reached the combined endpoint. Patients with higher NYHA class had shorter event-free survival compared to patients with NYHA class II/III (log-rank, p < 0.001) and higher all cause-mortality (log-rank, p = 0.01). In multivariate analysis, NYHA class was an independent predictor of outcome (p = 0.008); atrial fibrillation, diabetes mellitus, higher N-terminal pro–B-type natriuretic peptide (NT-proBNP), and lower hemoglobin were also predictive of outcome. TTE parameters predictive of worse outcomes were larger right ventricular (RV) end-diastolic dimension, visually impaired RVEF, and tricuspid annular plane excursion <16 mm. Higher systolic pulmonary artery pressure was also predictive of worse outcomes in multivariate analysis. By multivariate Cox regression, only NYHA class (p = 0.040), NT-proBNP (p < 0.01), and visually impaired RV function on TTE (p = 0.001) remained significantly associated with the primary outcome.