Influence of Right Ventricular Dysfunction on Outcomes of Left Ventricular Non-compaction Cardiomyopathy

Abstract

BackgroundVarious adverse outcomes such as mortality and rehospitalization are associated with left ventricular non-compaction (LVNC). Due to data limitations, prospective risk assessment for LVNC remains challenging. This study aimed to investigate the influence of right ventricular (RV) dysfunction on the clinical outcomes of patients with LVNC through accurate and comprehensive measurements of RV function.Methods and ResultsOverall, 117 patients with LVNC (47.6 ± 18.3 years, 34.2% male) were enrolled, including 53 (45.3%) and 64 (54.7%) patients with and without RV dysfunction, respectively. RV dysfunction was defined as meeting any two of the following criteria: (i) tricuspid annular systolic excursions <17 mm, (ii) tricuspid S′ velocity <10 cm/s, and (iii) RV fractional area change (FAC) <35%. The proportion of biventricular involvement was significantly higher in patients with RV dysfunction than in controls (p = 0.0155). After a follow-up period of 69.0 [33.5, 96.0] months, 18 (15.4%) patients reached the primary endpoint (all-cause mortality), with 14 (26.4%) and 4 (6.3%) from the RV dysfunction group and normal RV function group, respectively. The Kaplan–Meier method and log-rank test revealed that patients with RV dysfunction had a higher risk of all-cause mortality than those in the control group (hazard ratio [HR]: 5.132 [2.003, 13.15], p = 0.0013). Similar results were obtained for patients with left ventricular ejection fraction (LVEF) <50% [HR, 6.582; 95% confidence interval (CI), 2.045–21.19; p = 0.0367]. The relationship between RV dysfunction and heart failure rehospitalization and implantation of implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy (CRT) was not statistically significant (both p > 0.05). The multivariable Cox proportional hazard modeling analysis showed that RV dysfunction (HR: 4.950 [1.378, 17.783], p = 0.014) and impaired RV global longitudinal strain (RVGLS) (HR: 1.103 [1.004, 1.212], p = 0.041) were independent predictors of mortality rather than increased RV end-diastolic area and decreased LVEF (both p > 0.05).ConclusionsRV dysfunction is associated with the prognosis of patients with LVNC.

Abnormal circulating steroids refine risk of progression to heart failure in ischemic heart disease

“…47 These excess corticosteroids may play an important role in pathways involved in endothelial dysfunction, which has been proposed to cause relentless hypoxia in the cardiovascular microcirculation and consequently myocardial injury followed by increased myocardial fibrosis. 48,49 The association between the two-corticosteroid precursor-based CMD score and the IHF outcome in our study further suggests the notion of a vital role of corticosteroids in the pathogenesis of IHF. Nonetheless, further studies are necessary to confirm these findings and their pathophysiologic relevance.…”

Highlights of right ventricular characteristics of left ventricular noncompaction using 3D echocardiography

“…However, our study did not show volumetric differences, which might be due to the smaller patient population. Moreover, a novel study of 117 noncompacted participants using 2D STE demonstrated that decreased conventional parameters for right ventricular function (tricuspid annular systolic excursions, tricuspid S′ velocity, and RV fractional area change and reduced right ventricular strain values) were all independent predictors of mortality, regardless of the left ventricular EF [21] , [22] .…”

Characteristics of the right ventricle in left ventricular noncompaction with reduced ejection fraction in the light of dilated cardiomyopathy

“…Interestingly, the abovementioned correspondences were not observable in the DCM group. It must be emphasized that RV involvement in LVNC has a worse prognosis based on literature data [ 32 , 33 ]. Regarding our results, RV trabeculation might have an impact on the deterioration of RV strains.…”