Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure

Abstract

AimsThe aim of this study was to investigate the prognostic impact of right ventricular (RV) size in patients with chronic heart failure. Methods and resultsNormal volunteers (n ¼ 80) and patients (n ¼ 380) with left ventricular (LV) ejection fraction ,45% on echocardiography and on optimal treatment for heart failure underwent cardiac magnetic resonance imaging with measurement of LV and RV volumes, mass and ejection fraction. The mean and the standard deviation (SD) of the RV end-systolic volume index in normal subjects were used to define the normal range as: mean RV end-systolic volume index +2 SD. Patients with dilated RV (.2 SD beyond the mean) (25%) had more frequent evidence of fluid overload in clinical examination and greater LV dimensions (P , 0.0001). During follow-up (median 45, interquartile range: 28 -66 months), 37% of patients with and 24% without RV dilation died (log-rank test ¼ 8.4; P ¼ 0.004). In a multivariable Cox regression model, including 13 other clinical variables, RV (HR: 1.08/10 mL/m 2 , 95% CI: 1.00-1.18, P ¼ 0.044), but not LV, end-systolic volume index predicted a worse outcome. ConclusionTwenty-five per cent of patients with heart failure due to LV systolic dysfunction have a dilated right ventricle. Greater RV dimensions predict mortality in patients with chronic heart failure. Treatments aimed at preserving or enhancing RV structure and function, possibly by unloading the RV by reducing pulmonary vascular resistance or left atrial pressure, should be investigated.--

Right ventricular remodelling in systemic hypertension: a cardiac MRI study

“…In this latter regard and in confirmation of previous echocardiographic data,16–19 we showed a highly significant and positive biventricular association of early peak filling rate implying that impaired right ventricular diastolic mechanics should be considered part of the complex of cardiac effects of the uncomplicated phase of systemic hypertension. Whether those right-sided functional abnormalities represent the preclinical antecedent of those complicating the course of hypertensive heart failure34 is an interesting hypothesis to be tested prospectively. Similar conclusions can be drawn from the strong, positive association of right ventricular EF with its left-sided counterpart, not surprising because the two ventricles share common circular and spiral muscle fibre bundles, and the septal wall, a structure involved in both right ventricular ejection and filling and ventricular interdependence, ie, the transmission of forces from one to the other ventricle independent of neural, humoural or circulatory influences 35.…”

Automated assessment of heart chamber volumes and function in patients with previous myocardial infarction using multidetector computed tomography

“…16,18 For the outflow tract of the right ventricle only the part surrounded by thick trabeculated wall was considered as part of the RV volume, a method that previously has been used. 19,20 For the left atrium, the phases of interest were the minimum and maximal volume. The LA volumes were traced and calculated the same way as for the ventricles.…”

Evaluation of Right Ventricular Function

“…However, recent data indicate that most patients with conventional pacemakers, and probably those with cardioverter-defibrillators (including the great majority that are not marketed as being "MRI safe") can safely undergo MRI procedures provided they are not pacemaker dependent and that there is adequate monitoring [26]. MRI-based measurements of RV EF are strong predictors of outcome in patients with a wide range of heart failure severity [27], and MRI-derived measurements of size and EF are increasingly being used as gold standards for evaluating other techniques.…”