The Prevalence, Correlates, and Impact on Cardiac Mortality of Right Ventricular Dysfunction in Nonischemic Cardiomyopathy.
OBJECTIVES
This study sought to determine the prevalence, correlates, and impact on cardiac mortality of right ventricular (RV) dysfunction in nonischemic cardiomyopathy.


BACKGROUND
Current heart failure guidelines place little emphasis on RV assessment due to limited available data on determinants of RV function, mechanisms leading to its failure, and relation to outcomes.


METHODS
We prospectively studied 423 patients with cardiac magnetic resonance (CMR). The pre-specified study endpoint was cardiac mortality. In 100 patients, right heart catheterization was performed as clinically indicated.


RESULTS
During a median follow-up time of 6.2 years (interquartile range: 2.9 to 7.6 years), 101 patients (24%) died of cardiac causes. CMR right ventricular ejection fraction (RVEF) was a strong independent predictor of cardiac mortality after adjustment for age, heart failure-functional class, blood pressure, heart rate, serum sodium, serum creatinine, myocardial scar, and left ventricular ejection fraction (LVEF). Patients with the lowest quintile of RVEF had a nearly 5-fold higher cardiac mortality risk than did patients with the highest quintile (hazard ratio: 4.68; 95% confidence interval [CI]: 2.43 to 9.02; p < 0.0001). RVEF was positively correlated with LVEF (r = 0.60; p < 0.0001), and inversely correlated with right atrial pressure (r = -0.32; p = 0.001), pulmonary artery pressure (r = -0.34; p = 0.0005), transpulmonary gradient (r = -0.28; p = 0.006) but not with pulmonary wedge pressure (r = -0.15; p = 0.13). In multivariable logistic regression analysis of CMR, clinical, and hemodynamic data the strongest predictors of right ventricular dysfunction were LVEF (odds ratio [OR]: 0.85; 95% CI: 0.78 to 0.92; p < 0.0001), transpulmonary gradient (OR: 1.20; 95% CI: 1.09 to 1.32; p = 0.0003), and systolic blood pressure (OR: 0.97; 95% CI: 0.94 to 0.99; p = 0.02).


CONCLUSIONS
CMR assessment of RVEF provides important prognostic information independent of established risk factors and LVEF in heart failure patients with nonischemic cardiomyopathy. Right ventricular dysfunction is strongly associated with both indices of intrinsic myocardial contractility and increased afterload from pulmonary vascular dysfunction.
['Pueschner|Andreas|A|', 'Chattranukulchai|Pairoj|P|', 'Heitner|John F|JF|', 'Shah|Dipan J|DJ|', 'Hayes|Brenda|B|', 'Rehwald|Wolfgang|W|', 'Parker|Michele A|MA|', 'Kim|Han W|HW|', 'Judd|Robert M|RM|', 'Kim|Raymond J|RJ|', 'Klem|Igor|I|']
D000368:Aged D006328:Cardiac Catheterization D009202:Cardiomyopathies D002423:Cause of Death D016009:Chi-Square Distribution D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D016015:Logistic Models D019028:Magnetic Resonance Imaging, Cine D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009200:Myocardial Contraction D009657:North Carolina D016017:Odds Ratio D015995:Prevalence D011379:Prognosis D016016:Proportional Hazards Models D011446:Prospective Studies D012307:Risk Factors D013318:Stroke Volume D013997:Time Factors D018497:Ventricular Dysfunction, Right D016277:Ventricular Function, Left D016278:Ventricular Function, Right
nonischemic cardiomyopathy heart failure right ventricular dysfunction