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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
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The prognostic role of right ventricular dysfunction in patients with hypertrophic cardiomyopathy

Saima Mushtaq1, Lorenzo Monti2,3, Alexia Rossi2,3

  • 1Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138, Milan, Italy.

The International Journal of Cardiovascular Imaging
|May 5, 2023
PubMed

Insights

Right ventricular (RV) abnormalities detected by cardiac magnetic resonance (CMR) imaging can predict major adverse cardiac events (MACE) in patients with hypertrophic cardiomyopathy (HCM). These RV findings, along with left atrium diameter, are crucial for prognostic assessment in HCM.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) is typically characterized by left ventricular (LV) hypertrophy.
  • However, right ventricular (RV) involvement, including hypertrophy and functional changes, is increasingly recognized in HCM patients.
  • Cardiac magnetic resonance (CMR) is a key imaging modality for assessing cardiac structure and function.

Purpose of the Study:

  • To evaluate RV size and function in a large cohort of HCM patients using CMR.
  • To determine if RV parameters, in conjunction with other CMR findings, can predict major adverse cardiac events (MACE).

Main Methods:

  • A prospective cohort study involving 315 HCM patients from two centers (2011-2017).
  • CMR studies were performed to assess LV and RV size, function, and myocardial late gadolinium enhancement (LGE).
  • MACE included ventricular arrhythmias, heart failure hospitalization, and cardiac death, with a mean follow-up of 65 months.

Main Results:

  • Patients who experienced MACE had significantly larger left atrium diameter, increased LV mass, and more myocardial LGE compared to those without events.
  • MACE patients also exhibited lower RV stroke volume index, higher prevalence of RV hypertrophy, and reduced RV ejection fraction.
  • Multivariate analysis identified left atrium diameter and RV stroke volume index as the strongest predictors of MACE.

Conclusions:

  • Anatomic and functional RV anomalies detected by CMR play a significant role in predicting prognosis for HCM patients.
  • RV assessment using CMR should be integrated into the risk stratification of individuals with HCM.
  • These findings highlight the importance of evaluating both ventricles in HCM for comprehensive risk assessment.

Keywords:
Cardiac magnetic resonanceHypertrofic cardiomyopathyRight ventricle

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