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Manca P, Nuzzi V, Cannatà A, Castrichini M, Bromage DI, De Luca A, Stolfo D, Schulz U, Merlo M, Sinagra G. The right ventricular involvement in dilated cardiomyopathy: prevalence and prognostic implications of the often-neglected child. Heart Fail Rev 2022; 27:1795-1805. [PMID: 35315505 PMCID: PMC9388461 DOI: 10.1007/s10741-022-10229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by left or biventricular systolic impairment. Historically, most of the clinical attention has been devoted to the evaluation of left ventricular function and morphology, while right ventricle (RV) has been for many years the forgotten chamber. Recently, progresses in cardiac imaging gave clinicians precious tools for the evaluation of RV, raising the awareness of the importance of biventricular assessment in DCM. Indeed, RV involvement is far from being uncommon in DCM, and the presence of right ventricular dysfunction (RVD) is one of the major negative prognostic determinants in DCM patients. However, some aspects such as the possible role of specific genetic mutations in determining the biventricular phenotype in DCM, or the lack of specific treatments able to primarily counteract RVD, still need research. In this review, we summarized the current knowledge on RV involvement in DCM, giving an overview on the epidemiology and pathogenetic mechanisms implicated in determining RVD. Furthermore, we discussed the imaging techniques to evaluate RV function and the role of RV failure in advanced heart failure.
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Affiliation(s)
- Paolo Manca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Vincenzo Nuzzi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Antonio Cannatà
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Matteo Castrichini
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Antonio De Luca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Uwe Schulz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
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Purmah Y, Lei LY, Dykstra S, Mikami Y, Cornhill A, Satriano A, Flewitt J, Rivest S, Sandonato R, Seib M, Lydell CP, Howarth AG, Heydari B, Merchant N, Bristow M, Fine N, Gaztanaga J, White JA. Right Ventricular Ejection Fraction for the Prediction of Major Adverse Cardiovascular and Heart Failure-Related Events: A Cardiac MRI Based Study of 7131 Patients With Known or Suspected Cardiovascular Disease. Circ Cardiovasc Imaging 2021; 14:e011337. [PMID: 33722059 DOI: 10.1161/circimaging.120.011337] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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.
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Affiliation(s)
- Yanish Purmah
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Lucy Y Lei
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Aidan Cornhill
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Michelle Seib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Michael Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Nowell Fine
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
| | - Juan Gaztanaga
- Department of Medicine, New York University Winthrop, Mineola (J.G.)
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta (Y.P., L.Y.L., S.D., Y.M., A.C., A.S., J.F., S.R., R.S., M.S., C.P.L., A.G.H., B.H., N.M., M.B., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Diagnostic Imaging (C.P.L., N.M., M.B., J.A.W.), Cumming School of Medicine, University of Calgary, Canada.,Department of Cardiac Sciences (A.G.H., B.H., N.F., J.A.W.), Cumming School of Medicine, University of Calgary, Canada
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