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Prevalence of ventricular discordance and its relation to functional capacity in idiopathic dilated cardiomyopathy

Gunnar Plehn1, Julia Vormbrock, Lutz Lefringhausen

  • 1Department of Cardiology and Angiology, Marienhospital Herne, University of Bochum, Germany. gunnar.plehn@ruhr-uni-bochum.de

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|March 14, 2009
PubMed

Insights

In idiopathic dilated cardiomyopathy (IDC), left and right ventricular dilatation varies. Ventricular volume discordance strongly correlates with left ventricular enlargement but adds little to understanding exercise limitations beyond left ventricular measurements.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Heart Failure Research

Background:

  • Idiopathic dilated cardiomyopathy (IDC) is characterized by left ventricular (LV) dilatation, but right ventricular (RV) involvement varies.
  • The prevalence and functional significance of relative biventricular dilatation in IDC remain understudied.
  • Cardiac magnetic resonance imaging (MRI) offers a comprehensive tool for assessing ventricular morphology and function.

Purpose of the Study:

  • To investigate the prevalence and functional importance of relative left and right ventricular dilatation in IDC patients using cardiac MRI.
  • To determine the correlation between ventricular volume discordance and the extent of LV enlargement.
  • To assess the contribution of biventricular assessment to understanding exercise capacity limitations in IDC.

Main Methods:

  • Prospective study of 58 IDC patients with LV ejection fraction <40% and NYHA class ≥2.
  • Cardiac MRI performed on a 1.5 Tesla scanner for detailed RV and LV dimensional and functional analysis.
  • Cardiopulmonary exercise testing used to evaluate exercise capacity; patients stratified into tertiles by LV end-diastolic volume.

Main Results:

  • Significant heterogeneity in relative RV and LV dilatation observed in IDC patients compared to controls.
  • Strong correlation (r=0.8, P<0.001) found between ventricular volume discordance and LV enlargement.
  • LV/RV volume ratios differed significantly across tertiles (P<0.001); LV ejection fraction was the sole independent predictor of maximum oxygen consumption.

Conclusions:

  • Ventricular volume discordance in IDC is strongly linked to the degree of LV enlargement.
  • Comprehensive biventricular MRI assessment provides limited additional insight into exercise tolerance mechanisms compared to isolated LV evaluation.
  • LV function remains the primary determinant of exercise capacity in IDC patients.
Abstract

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