Right Ventricular Ejection Fraction for the Prediction of Major Adverse Cardiovascular and Heart Failure-Related Events

Abstract

Background: There is increasing evidence that right ventricular ejection fraction (RVEF) may provide incremental value to left ventricular (LV) ejection fraction for the prediction of major adverse cardiovascular events. To date, generalizable utility for RVEF quantification in patients with cardiovascular disease has not been established. Using a large prospective clinical outcomes registry, we investigated the prognostic value of RVEF for the prediction of major adverse cardiovascular events- and heart failure-related outcomes. Methods: Seven thousand one hundred thirty-one consecutive patients with known or suspected cardiovascular disease undergoing cardiovascular magnetic resonance imaging were prospectively enrolled. Multichamber volumetric quantification was performed by standardized operational procedures. Patients were followed for the primary composite outcome of all-cause death, survived cardiac arrest, admission for heart failure, need for transplantation or LV assist device, acute coronary syndrome, need for revascularization, stroke, or transient ischemic attack. A secondary, heart failure focused outcome of heart failure admission, need for transplantation/LV assist device or death was also studied. Results: Mean age was 54±15 years. The mean LV ejection fraction was 55±14% (range 6%–90%) with a mean RVEF of 54±10% (range 9%–87%). At a median follow-up of 908 days, 870 (12%) patients experienced the primary composite outcome and 524 (7%) the secondary outcome. Each 10% drop in RVEF was associated with a 1.3-fold increased risk of the primary outcome ( P <0.001) and 1.5-fold increased risk of the secondary outcome ( P <0.001). RVEF was an independent predictor following comprehensive covariate adjustment, inclusive of LV ejection fraction. Patients with an RVEF<40% experienced a 3.1-fold risk of the primary outcome ( P <0.001) with a 1-year cumulative event rate of 22% versus 7% above this cutoff. Conclusions: RVEF is a powerful and independent predictor of major adverse cardiac events with broad generalizability across patients with known or suspected cardiovascular disease. These findings support migration towards biventricular phenotyping for the classification of risk in clinical practice. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04367220.

Prognostic Value of the Three-Dimensional Right Ventricular Ejection Fraction in Patients With Asymptomatic Aortic Stenosis

“…The prognostic impact of right ventricular (RV) function has garnered increased interest in this parameter in recent years. RV dysfunction can affect the risk of HF via a negative impact on cardiac output and ventricular interactions in various heart diseases ( 11 ). Genereux and colleagues have proposed a new concept called “cardiac damage stage” for risk stratification of asymptomatic AS patients ( 12 , 13 ).…”

CILP1 as a biomarker for right ventricular dysfunction in patients with ischemic cardiomyopathy

“…5 Additionally, in a large CMR cohort of 7131 patients with known or suspected cardiovascular disease, RVEF < 40% was an independent predictor of heart failure admission, need for transplantation/LV-assisted device, or death. 19 Increased RVESVI as a parameter of RV dilation was also associated with higher mortality in a CMR cohort of patients with LV heart failure. 20 In our study, we used CMR imaging, which is the current standard for measuring LV and RV dimensions and function with good reliability and reproducibility, 6,21 to analyze associations of CILP1 concentrations with prognostic parameters of LV and RV remodeling in patients with ICM and healthy controls.…”

Mid-wall striae fibrosis predicts heart failure admission, composite heart failure events, and life-threatening arrhythmias in dilated cardiomyopathy

“…The study was a sub-cohort analysis of the Cardiovascular Imaging Registry of Calgary (CIROC) at the Libin Cardiovascular Institute (NCT04367220). As previously described 18 , all patients in Southern Alberta referred for clinically indicated Cardiac MRI are prospectively enrolled with data collection performed using commercial software (cardioDI™, Cohesic Inc., Calgary) to deliver tablet-based patient engagement and consent, standardized patient-reported health questionnaires, indication-driven test protocolling and standardized reporting, followed by automated linkage to electronic health record (EHR) data.…”

“…: cardiac amyloid), or constrictive pericardial disease. Only patients completing a minimum of 12-months clinical follow-up were considered eligible 18 .…”

“…CMR imaging was performed using 3-Tesla clinical scanners (Prisma or Skyra, Siemens Healthcare, Erlangen, Germany), as previously described 18 . Standardized CMR imaging protocols were used, inclusive of cine imaging using a steady-state free precession (SSFP) pulse sequence in sequential short-axis views from above the pulmonary valve to beyond the cardiac apex.…”