Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

Abstract

Aims Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF). Methods and results Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan–Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560–1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09–1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function. Conclusion RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.

The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping

“…Presence and extension of fibro-fatty myocardial replacement (ARVC pathologic hallmark) can be detect using LGE imaging and is found in up to 88% of patients, with a diagnostic accuracy of 98% when wall motion alterations and pre-/post-contrast signal abnormalities were considered together [78][79][80], although LGE can be detected in other conditions (e.g., sarcoidosis, rheumatic disease, myocarditis) and its interpretation can be difficult due to RV limited thickness [81].…”

The Postoperative Paradoxical Septum (POPS): A Comprehensive Review on Physio-Pathological Mechanisms

“…Additionally, tissue characterization and deformation evaluation techniques have emerged as valuable tools to differentiate between IVS function and mere displacement [15,22,[59][60][61][62]. In this regard, Giubbini et al retrospectively compared subjects with previous anterior MI (all with pre-operative hypokinetic IVS) and others with stable angina (with pre-operative normokinetic LV) after CABG.…”

Assessment and management of Heart Failure in Patients with Chronic Kidney Disease

“…Echocardiography is also useful to estimate the volume status, trying to early identify patients with venous congestion and fluid overload through typical echocardiographic signs: right ventricular function calculated through some parameters such as the Fractional Area Change (FAC), the Tricuspid Annular Plane Systolic Excursion (TAPSE) and peak systolic velocity on Tissue Doppler (S′ wave) [54], tricuspid regurgitation [55], and inferior vena cava congestion [56] (Figure 2) and some haemodynamic parameters (esteem of central venous pressure, systolic pressure), lateral and septal longitudinal movement of the wall (E′), the mitral the inflow velocity (E) and their ratio E/E′, are parameters that relate to pulmonary capillary wedge pressure, (E/E′ >15 correspond approximately to >18 mmHg) [57,58]. Cardiac magnetic resonance (CMR) allows the morpho-functional study in patient with poor acoustic window or allows to evaluate the state of myocardial fibrosis and inflammation, useful for clarifying the progress of HF and assists echocardiography in identification the cause of HF [59][60][61].…”