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Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator
Laura Jimenez-Juan1,2, Gauri R Karur2,3, Kim A Connelly2,4,5
1Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto ON, Canada.
Insights
Primary prevention of sudden cardiac death with implantable cardioverter defibrillators (ICDs) often relies on left ventricular ejection fraction (LVEF). This study reveals a moderate correlation between LVEF and right ventricular ejection fraction (RVEF), indicating preserved RVEF in some patients with low LVEF, and vice versa.
Area of Science:
- Cardiology
- Cardiac Imaging
- Electrophysiology
Background:
- Implantable cardioverter defibrillator (ICD) indications for primary prevention of sudden cardiac death are primarily based on left ventricular ejection fraction (LVEF).
- Right ventricular ejection fraction (RVEF) is a recognized prognostic factor in various structural heart diseases linked to sudden cardiac death.
- The study investigates the relationship between right and left ventricular parameters using cardiovascular magnetic resonance (CMR).
Purpose of the Study:
- To explore the correlation between left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) in patients considered for ICD implantation.
- To assess the utility of RVEF in conjunction with LVEF for predicting sudden cardiac death risk in a diverse patient cohort.
- To determine the prevalence of preserved RVEF in patients with low LVEF and vice versa.
Main Methods:
- Retrospective analysis of 102 consecutive patients referred for LVEF assessment by CMR.
- Measurement of right and left ventricular function and volumes using cardiovascular magnetic resonance (CMR).
- Statistical analysis to determine the correlation between LVEF and RVEF and assess discordance.
Main Results:
- Mean LVEF was 28±11% and mean RVEF was 44±12%.
- A significant but moderate correlation (r=0.40, p<0.001) was observed between LVEF and RVEF.
- 37% of patients with LVEF <35% had preserved RVEF, and 56% of patients with LVEF ≥35% had right ventricular systolic dysfunction.
Conclusions:
- There is a moderate positive correlation between LVEF and RVEF in patients considered for ICD.
- A substantial number of patients exhibit discordance between LVEF and RVEF, suggesting RVEF provides additional prognostic information.
- RVEF assessment may refine risk stratification for sudden cardiac death in patients undergoing ICD evaluation.
Background:
Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD.
Methods:
In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured.
Results:
In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m2 and 81±27 mL/m2, respectively. Eighty-six (84%) patients had a LVEF <35%, and 63 (62%) patients had right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF (r=0.40, p<0.001), 32 of 86 patients (37%) with LVEF <35% had preserved RVEF, while 9 of 16 patients (56%) with LVEF ≥35% had right ventricular systolic dysfunction (Kappa=0.041).
Conclusions:
Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.