2022/08 - Free-running cardiac and respiratory motion-resolved 5D whole-heart coronary cardiovascular magnetic resonance angiography in pediatric cardiac patients using ferumoxytol [Journal Club]-24-36 Right ventricular function

24-36 Right ventricular function

Pdf Summary

This study examined right ventricular (RV) function in 290 patients with hypertrophic cardiomyopathy (HCM) who still had preserved left ventricular ejection fraction (LVEF), comparing them with 30 healthy controls. Using cardiovascular magnetic resonance (CMR), the researchers measured RV ejection fraction (RVEF), RV strain, and related LV measures, and followed patients for clinical events over a median of 4.4 years. A subset of 63 patients also had repeat CMR after about 5.4 years.<br /><br />At baseline, HCM patients already showed subtle RV impairment: RV strain was worse than in controls, and RVEF was slightly lower, though still in the normal range. LV strain was also reduced, but LVEF remained preserved. Over time, both RV and LV strain declined, but only RVEF showed a significant drop; LVEF did not change significantly. This suggests RV function may deteriorate earlier than standard LV ejection fraction measures capture disease progression.<br /><br />Importantly, reduced RVEF predicted adverse outcomes. Lower RVEF independently associated with non-sustained ventricular tachycardia (NSVT) and a composite endpoint including NSVT, stroke, heart failure hospitalization, and cardiovascular death. RV longitudinal strain also predicted NSVT. In contrast, LVEF and LV global longitudinal strain were not independently predictive after adjustment. Patients with RVEF below 55% had higher risks of NSVT and composite cardiovascular events.<br /><br />The authors conclude that RV dysfunction is an important but underrecognized feature of HCM, can worsen over time despite preserved LVEF, and may improve risk stratification—especially early in the disease course.

Keywords

hypertrophic cardiomyopathy

right ventricular dysfunction

cardiovascular magnetic resonance

right ventricular ejection fraction

RV strain

preserved left ventricular ejection fraction

non-sustained ventricular tachycardia

clinical outcomes

myocardial strain

risk stratification