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Updated: Jun 19, 2025
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Prognostic value of right ventricular involvement in hypertrophic cardiomyopathy: A systematic review and
Stefano Figliozzi1, Pier-Giorgio Masci2, Lorenzo Monti3
1IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089 Milan, Italy.
Insights
Right ventricular dysfunction in hypertrophic cardiomyopathy (HCM) patients significantly increases adverse outcomes. This finding highlights the prognostic importance of assessing RV function for better risk stratification in HCM.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Prognostics
Background:
- Right ventricular (RV) involvement is common in hypertrophic cardiomyopathy (HCM) but its prognostic significance is unclear.
- This study assesses the prognostic value of RV involvement in HCM patients using systematic review and meta-analysis.
Approach:
- Systematic literature search of PubMed, ClinicalTrials.gov, and Cochrane Library databases.
- Included studies evaluated RV parameters (hypertrophy, volumes, function, LGE) via echocardiography or cardiac MRI.
- Analyzed association between RV parameters and a composite endpoint of adverse clinical outcomes.
Key Points:
- Meta-analysis of 12 articles with 4634 HCM patients.
- RV systolic dysfunction significantly increased adverse outcomes (HR 2.46; 95% CI 1.80-3.35).
- RV-fractional area change as a continuous variable also predicted prognosis (HR 0.96 per % increase).
Conclusions:
- RV dysfunction has an independent prognostic role in HCM patients.
- Findings emphasize the need for multi-parametric RV assessment for refined risk stratification.
- Future longitudinal studies are encouraged to validate these clinical insights.
Background:
Right ventricular (RV) involvement has been reported in one out of three patients with hypertrophic cardiomyopathy (HCM), however its prognostic significance remains unknown. We aimed to assess the prognostic value of RV involvement in patients with HCM through a systematic review and meta-analysis.
Methods:
A literature search was performed on PubMed, ClinicalTrials.gov and Cochrane Library databases from inception through November 15, 2023. Original articles enrolling HCM patients >18 years old and evaluating the association of RV parameters routinely assessed in clinical practice through trans-thoracic echocardiography or cardiac magnetic resonance (i.e., RV hypertrophy, volumes, systolic function, and late gadolinium enhancement) and the risk of a pre-defined composite endpoint including i) all cause death; ii) cardiac death; iii) heart transplantation; iv) heart failure-related hospitalization; v) atrial fibrillation; vi) ventricular tachycardia; and vii) stroke were retrieved. We pooled the effect of RV imaging variables on the combined clinical endpoint in terms of hazard ratio (HR) with 95% confidence interval (CI).
Results:
The meta-analysis included 12 articles and 4634 patients. The pooled analysis demonstrated that the presence of RV systolic dysfunction conveyed an increased risk of adverse outcomes (HR 2.46; 95% CI 1.80-3.35; P < 0.001), whereas other RV imaging parameters were not significantly associated with patients' prognosis, except for RV-fractional area change analyzed as a continuous variable (HR 0.96 per % increase; 95% CI 0.93-0.995; P = 0.025).
Conclusions:
Our results pinpoint a prognostic role of RV dysfunction, independent of left ventricular involvement, in patients with HCM, and future longitudinal studies, including multi-parametric RV assessment, are encouraged to provide clinically-relevant data to refine risk stratification in patients with HCM.
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