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Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future
Yoko Mikami1, Umjeet Jolly1, Bobak Heydari1
1From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
Insights
Right ventricular dysfunction independently predicts arrhythmic events in heart failure patients. This marker improves risk stratification, especially in those with mild to moderate left ventricular dysfunction, identifying high-risk individuals for sudden cardiac arrest.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Electrophysiology
Background:
- Left ventricular ejection fraction is the standard for implantable cardioverter defibrillator selection.
- This metric alone cannot identify all patients at risk for sudden cardiac arrest.
- Right ventricular function offers potential additional predictive value.
Purpose of the Study:
- To evaluate the incremental value of right ventricular ejection fraction (RVEF) in predicting arrhythmic events.
- To assess RVEF's predictive capability in patients with systolic dysfunction.
- To utilize cardiovascular magnetic resonance (CMR) as the gold standard for assessment.
Main Methods:
- 314 patients with ischemic or nonischemic cardiomyopathy underwent CMR.
- Left and right ventricular volumes were quantified from cine imaging.
- Right ventricular dysfunction was defined as RVEF ≤45%.
Main Results:
- 49 patients (15.6%) experienced sudden cardiac arrest or appropriate ICD therapy.
- RV dysfunction was an independent predictor of these events (HR=2.98, P=0.002).
- In patients with LVEF >35%, RV dysfunction showed a significant adjusted hazard ratio of 4.2 (P=0.02).
Conclusions:
- Right ventricular dysfunction is a robust, independent predictor of arrhythmic events.
- RVEF provides significant risk discrimination in patients with mild to moderate left ventricular dysfunction.
- This finding can enhance patient selection for ICD therapy.
Background:
Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance.
Methods And Results:
Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02).
Conclusions:
RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
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