Clinical and echocardiographic features of right ventricular dysfunction and biventricular dysfunction in children

In the pediatric population, right ventricular (RV) systolic dysfunction is uncommon and can often be overlooked. This study describes clinical and imaging characteristics of RV dysfunction in children. Features of isolated RV dysfunction are compared with features of biventricular dysfunction (BVD).

The study population included children with RV dysfunction at our institution between January 2015 and March 2022. Echocardiographic, cardiac magnetic resonance imaging (MRI), and clinical data were retrospectively collected and analyzed. Right ventricular dysfunction was defined as RV ejection fraction (RVEF) <45% on cardiac MRI, and RVEF <35% was considered severe. Patients were grouped as having isolated RV dysfunction or BVD if the concurrent left ventricular ejection fraction was <50%.

Sixty-five patients were included (median age 12.2 years). Thirty-two (49.2%) had isolated RV dysfunction, and 33 (50.8%) had BVD. Compared to those with BVD, patients with isolated RV dysfunction had similar cardiac index (2.9 vs. 2.4 mL/min/m², P = 0.057), but milder symptoms (96.9% vs. 57.6% were New York Heart Association class I-II, P < 0.001). Adverse cardiovascular (ACV) outcomes occurred in four patients with BVD and none with isolated RV dysfunction (P = 0.042). On echocardiogram, a combination of fractional area change (FAC) <35% and qualitative RV dysfunction correlated best with severe RV dysfunction by cardiac MRI.

Children with isolated RV dysfunction experience milder symptoms than those with BVD, and children with BVD are at high risk for ACV outcomes. Echocardiographic assessment of RV dysfunction is challenging, and combining abnormal FAC with qualitative assessment enhances the prediction of severe RV dysfunction in children.