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- Open Access
Evaluation of CMR predictors of right ventricular remodelling in dilated cardiomyopathy
© Tayal et al. 2016
- Published: 27 January 2016
- Leave Ventricular Ejection Fraction
- Cardiovascular Magnetic Resonance
- Dilate Cardiomyopathy
- Ventricular Systolic Function
- Reverse Remodelling
We have previously identified that right ventricular systolic dysfunction (RVSD), present in one third of patients with non-ischaemic dilated cardiomyopathy (DCM), is an independent predictor of all cause mortality and cardiac transplantation. CMR provides a robust and reliable way of quantifying RVSD.
The natural history of RVSD in DCM has not been formally evaluated. We sought to evaluate whether baseline left ventricular systolic function is predictive of the development of RVSD and whether progression of right-sided ventricular impairment is linked to progression of left-sided ventricular impairment.
130 DCM patients (mean age 53.9 years, 65% male) underwent 2 cardiovascular magnetic resonance (CMR) studies, with a median interval of 2.7 years between studies (IQR 1.4-4.7 years). CMR was performed on a 1.5T Siemens scanner.
DCM was diagnosed on conventional criteria (increased LV end diastolic volume indexed to body surface area and reduced left ventricular ejection fraction (LVEF) compared with reference ranges normalised for age and gender; absence of significant underlying coronary artery disease). RVSD was defined as right ventricular ejection fraction (RVEF) <45%.
Evaluated predictors of RV remodelling
CMR Imaging Predictors
Baseline LVEF, left ventricular mid wall fibrosis detected on LGE, mitral regurgitation, indexed left and right end diastolic and end systolic volumes.
Age, gender, ethnicity, medication history (use of diuretic, beta blockers, ACE inhibitors, Aldosterone Antagonists), symptom status (NYHA class), resting heart rate, and comorbidities (hypertension and atrial fibrillation).
Mean baseline LVEF was 42% (± 12%) and RVEF 53% (± 16%). Thirty-two patients (25%) had RVSD at baseline, and 22 at follow up (17%). Mean follow up LVEF was 47% (± 13%) and RVEF 54% (± 14%).
When controlling for baseline RVEF, baseline LVEF was not predictive of follow up RVEF (p=0.19, 95% confidence interval -3% to 0.7%). When controlling for potential confounders, baseline LVEF remained non significant in predicting follow up RVEF.
These data show no evidence that progression of RVSD in DCM is dependent on baseline left ventricular systolic function.
However, adverse or reverse remodelling of RV function mirrors the change in LV function.
This suggests therefore that patients with significant LV impairment but normal RV function at baseline may not necessarily develop RVSD. However if LV function improves or deteriorates then RV function is likely to follow a similar course.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.