BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE), Doppler tissue imaging-derived tricuspid lateral annular systolic wave velocity (S'), and right ventricular fractional area change (RV-FAC) are the most widely used echocardiographic measures of right ventricular systolic function. This study aimed to compare the prognostic value of TAPSE, S', and RV-FAC in a large cohort of patients with chronic heart failure. METHODS: Consecutive outpatients with heart failure and left ventricular ejection fraction <
50% on guideline-recommended therapies undergoing echocardiography were followed up for the end point of cardiac and all-cause death. RESULTS: Among 1590 patients (71±12 years, 77% men, left ventricular ejection fraction 34%±9%), 202 (13%) died from cardiac causes during a median follow-up of 28 (interquartile range, 14-40) months. According to the recommended cut points for TAPSE (<
17 mm), S' (<
9.5 cm/s), or RV-FAC (<
35%), right ventricular systolic dysfunction was found in 37%, 40%, and 35% of patients, respectively, with 21%, 31%, and 33% of discordant cases comparing TAPSE versus S', TAPSE versus RV-FAC, and S' versus RV-FAC. Both TAPSE <
17 mm and RV-FAC <
35% were more accurate than S' <
9.5 cm/s in predicting the risk of cardiac death ( CONCLUSIONS: In patients with chronic heart failure and left ventricular ejection fraction <
50%, TAPSE, and RV-FAC are more accurate than S' in predicting the risk of cardiac and all-cause death. Considering both RV-FAC and TAPSE provides incremental prognostic value.