Right Ventricular Function at Cardiac MRI Predicts Cardiovascular Events in Patients with an Implantable Cardioverter-Defibrillator

Abstract

Background: Right ventricular ejection fraction (RVEF) is an independent predictor of death and adverse cardiovascular outcomes in patients with various cardiac conditions.Purpose: To investigate whether RVEF, measured with cardiac MRI, is a predictor of appropriate shock or death in implantable cardioverter-defibrillator (ICD) recipients for primary and secondary prevention of sudden cardiac death. Materials and Methods:This retrospective, multicenter, observational study included patients who underwent cardiac MRI before ICD implantation between January 2007 and May 2017. Right ventricular end-diastolic and end-systolic volumes and RVEF were measured with cardiac MRI. The primary end point was a composite of all-cause mortality or appropriate ICD shock. The secondary end point was all-cause mortality. The association between RVEF and primary and secondary outcomes was evaluated by using multivariable Cox regression analysis. Potential interactions were tested between primary prevention, ischemic cause, left ventricular ejection fraction (LVEF), and RVEF.Results: Among 411 patients (mean age 6 standard deviation, 60 years; 315 men) during a median follow-up of 63 months, 143 (35%) patients experienced an appropriate ICD shock or died. In univariable analysis, lower RVEF was associated with greater risks for appropriate ICD shock or death and for death alone (log-rank trend test, P = .003 and .005 respectively). In multivariable Cox regression analysis adjusting for age at ICD implantation, LVEF, ICD indication (primary vs secondary), ischemic heart disease, and late gadolinium enhancement, RVEF was an independent predictor of the primary outcome (hazard ratio [

Ressonância Magnética Cardíaca como Ferramenta Diagnóstica Etiológica em Pacientes Recuperados de Morte Súbita Cardíaca ou Arritmias Ventriculares Instáveis

“… 25 In addition, right ventricular dysfunction was identified in nearly one-third of our sample and recent publications established its central role in ICD firings and SCD events. 26 , 27 Another possible explanation for this finding is the presence of many Chagas cardiomyopathy patients in our sample, an entity known to affect early the right ventricle. 28 Late gadolinium enhancement was identified in 71.9% of our sample.…”

“… 25 Além disso, identificou-se a disfunção ventricular direita em quase um terço de nossa amostra e publicações recentes estabeleceram seu papel central nos acionamentos de CDI e nos eventos de MSC. 26 , 27 Outra possível explicação para esse achado é a presença de muitos pacientes com cardiomiopatia chagásica em nossa amostra, entidade conhecida por afetar precocemente o ventrículo direito. 28 Identificou-se realce tardio com gadolínio em 71,9%, da nossa amostra.…”

Clinical Usefulness of Right Ventricle–Pulmonary Artery Coupling in Cardiovascular Disease

“…RVEF is the most common used index of RV systolic function in everyday clinical practice and is strongly predictive of adverse outcomes in patients with a variety of cardiovascular diseases [ 54 , 55 ]. It has been confirmed that a lower RVEF/PASP ratio was associated with an increased risk of heart failure (HF) or death [ 37 ].…”