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Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure
Author(s) -
Bourantas Christos V.,
Loh Huan P.,
Bragadeesh Thanjavur,
Rigby Alan S.,
Lukaschuk Elena I.,
Garg Scot,
Tweddel Ann C.,
Alamgir Farqad M.,
Nikitin Nikolay P.,
Clark Andrew L.,
Cleland John G.F.
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq161
Subject(s) - medicine , heart failure , cardiology , magnetic resonance imaging , cardiac magnetic resonance , cardiac magnetic resonance imaging , radiology
Aims The aim of this study was to investigate the prognostic impact of right ventricular (RV) size in patients with chronic heart failure. Methods and results Normal volunteers ( n = 80) and patients ( n = 380) with left ventricular (LV) ejection fraction <45% on echocardiography and on optimal treatment for heart failure underwent cardiac magnetic resonance imaging with measurement of LV and RV volumes, mass and ejection fraction. The mean and the standard deviation (SD) of the RV end‐systolic volume index in normal subjects were used to define the normal range as: mean RV end‐systolic volume index +2 SD. Patients with dilated RV (>2 SD beyond the mean) (25%) had more frequent evidence of fluid overload in clinical examination and greater LV dimensions ( P < 0.0001). During follow‐up (median 45, interquartile range: 28–66 months), 37% of patients with and 24% without RV dilation died (log‐rank test = 8.4; P = 0.004). In a multivariable Cox regression model, including 13 other clinical variables, RV (HR: 1.08/10 mL/m 2 , 95% CI: 1.00–1.18, P = 0.044), but not LV, end‐systolic volume index predicted a worse outcome. Conclusion Twenty‐five per cent of patients with heart failure due to LV systolic dysfunction have a dilated right ventricle. Greater RV dimensions predict mortality in patients with chronic heart failure. Treatments aimed at preserving or enhancing RV structure and function, possibly by unloading the RV by reducing pulmonary vascular resistance or left atrial pressure, should be investigated.