Right ventricular dysfunction in patients with idiopathic dilated cardiomyopathy: Prognostic value and predictive factors

Abstract

Background: Right ventricular (RV) dysfunction is an important predictor of impaired prognosis in idiopathic dilated cardiomyopathy.

Aims: To determine the prognostic role of RV dysfunction, independent of left ventricular (LV) dysfunction.

Methods: A total of 136 consecutive patients (73% men; mean age 59.0±13.2 years) with idiopathic dilated cardiomyopathy (LV ejection fraction ≤ 45%) were enrolled retrospectively. Thirty-four patients (25%, group 1) presented with RV dysfunction, defined as tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm; 102 patients (group 2) had preserved RV function.

Results: Mean LV ejection fraction was 27.5±8.7%. Mean TAPSE was 18.6±5.4 mm (15-21.8 mm). Multivariable predictors of RV dysfunction were LV outflow tract time-velocity integral (odds ratio 0.8, 95% confidence interval [CI] 0.7-0.9; P=0.003) and E-wave deceleration time ≤ 145 ms (odds ratio 4.1, 95% CI 1.3-12.8; P=0.017). Major adverse cardiac event-free survival rates at 1 and 2 years were 64% and 55%, respectively, in group 1 and 87% and 79%, respectively, in group 2 (P=0.002). Both by multivariable analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictor for major adverse cardiac events (hazard ratio 3.2, 95% CI 1.3-7.6; P=0.009), along with right atrium area and age.

Conclusion: In idiopathic dilated cardiomyopathy, RV dysfunction with TAPSE ≤ 15 mm offers additional prognostic information, independent of the extent of LV dysfunction.

Keywords: Analyse de propensité; Cardiomyopathie dilatée; Dilated cardiomyopathy; Dysfonction ventriculaire droite; Heart failure; Insuffisance cardiaque; Propensity analysis; Right ventricular dysfunction.