Aetiology and outcomes of severe right ventricular dysfunction

Abstract

Aims Right ventricular dysfunction (RVD) is an important determinant of functional status and survival in various diseases states. Data are sparse on the epidemiology and outcome of patients with severe RVD. This study examined the characteristics, aetiology, and survival of patients with severe RVD. Methods and results Retrospective study of consecutive patients with severe RVD diagnosed by transthoracic echocardiography (TTE) between 2011 and 2015 in a single tertiary referral institution. Patients with prior cardiac surgery, mechanical assist devices, and congenital heart disease were excluded. Primary endpoint was all-cause mortality. In 64 728 patients undergoing TTE, the prevalence of ≥mild RVD was 21%. This study focused on the cohort of 1299 (4%) patients with severe RVD; age 64 ± 16 years; 61% male. The most common causes of severe RVD were left-sided heart diseases (46%), pulmonary thromboembolic disease (18%), chronic lung disease/hypoxia (CLD; 17%), and pulmonary arterial hypertension (PAH; 11%). After 2 ± 2 years of follow-up, 701 deaths occurred, 66% within the first year of diagnosis. The overall probability of survival at 1- and 5 years for the entire cohort were 61% [95% confidence interval (CI) 58–64%] and 35% (95% CI 31–38%), respectively. In left-sided heart diseases, 1- and 5-year survival rates were 61% (95% CI 57–65%) and 33% (95% CI 28–37%), respectively; vs. 76% (95% CI 68–82%) and 50% (95% CI 40–59%) in PAH, vs. 71% (95% CI 64–76%) and 49% (95% CI 41–58%) in thromboembolic diseases, vs. 42% (95% CI 35–49%) and 8% (95% CI 4–15%) in CLD (log-rank P < 0.0001). Presence of ≥moderate tricuspid regurgitation portended worse survival in severe RVD. Conclusion One-year mortality of patients with severe RVD was high (∼40%) and dependent on the aetiology of RVD. Left-sided heart diseases is the most common cause of severe RVD but prognosis was worst in CLD.

Care of patients with pulmonary arterial hypertension during the coronavirus (COVID‐19) pandemic

“…The same experience seems to be that in the US so far (personal communication). However, based on prior publications evaluating the effects of acute RHF superimposed on systemic infection, [15][16][17][18] it is likely that RHF and concomitant COVID-19 infection will lead to increased mortality in the PAH patient.…”

Characteristics and prognostic value of right ventricular (dys)function in patients with non‐ischaemic dilated cardiomyopathy assessed with cardiac magnetic resonance imaging

“…[4][5][6] A recent study demonstrated that severe RV dysfunction was most frequently seen in patients with left sided heart disease, up to 46%. 7 Echocardiographical RV analysis remains challenging due to the complex asymmetrical anatomy and extensive trabeculated myocardium. 8 Cardiac magnetic resonance (CMR) imaging is considered the gold standard for RV analysis and quantification providing high accuracy and reproducibility.…”

“…Probable causes of RV dysfunction include primary RV involvement in a biventricular cardiomyopathy causing intrinsic contractile dysfunction or secondary RV involvement resulting from alterations in RV loading conditions due to LV impairment 4–6 . A recent study demonstrated that severe RV dysfunction was most frequently seen in patients with left sided heart disease, up to 46% 7 . Echocardiographical RV analysis remains challenging due to the complex asymmetrical anatomy and extensive trabeculated myocardium 8 .…”

Understanding and recognition of the right ventricular function and dysfunction via a numerical study

“…Actually, the circulatory system is a closed-loop where the function of both ventricles is crucial. Therefore, not infrequently, impairment of one of the two ventricles precipitates impairment of the other 9 . Although LV dysfunction is most common, a recent study reported that RV myocardial infarction is not an infrequent problem, with an estimated occurrence of about 20-50% among patients with inferior myocardial infarction 10 .…”