Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy

Juillière, Yves; Barbier, George H.; Feldmann, L.; Grentzinger, A.; Danchin, Nicolás; Cherrier, F

doi:10.1093/oxfordjournals.eurheartj.a015231

Cited by 262 publications

(148 citation statements)

References 27 publications

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“…Right ventricular (RV) function plays an important role in determining cardiac output and functional capacity in humans [1,28]. RV dysfunction has been observed in various cardiac disorders such as pulmonary hypertension (PH) [17,37], idiopathic dilated cardiomyopathy (DCM) [22], and heart failure [7,8,27].RV function can be evaluated by cardiac catheterization with RV peak +/-dP/dt, Tau and RV ejection fraction. However, this method is invasive, and it is difficult to evaluate the RV function due to the complex structural geometry, mechanical properties, and contraction pattern of the right ventricle [12,16].…”

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“…RV dysfunction has been observed in various cardiac disorders such as pulmonary hypertension (PH) [17,37], idiopathic dilated cardiomyopathy (DCM) [22], and heart failure [7,8,27].…”

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Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

Teshima

Asano

Iwanaga

et al. 2006

The Journal of Veterinary Medical Science

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ABSTRACT. Right ventricular (RV) Tei index (index of myocardial performance) has been demonstrated to be clinically useful in estimating RV function in various human cardiac diseases. The purposes of this study were to validate the correlation between RV Tei index and RV function obtained by cardiac catheterization in healthy dogs, and to evaluate the RV Tei index in dogs with tricuspid regurgitation (TR). In healthy dogs, the RV Tei index significantly correlated with the RV peak +dP/dt (r=-0.80, p<0.0001) and -dP/dt (r=0.69, p=0.0001). In normal dogs, the RV Tei index was not significantly correlated with heart rate, body weight, and age. The RV Tei index significantly increased in dogs with moderate to severe TR (0.39 ± 0.35, p=0.0015), filariasis (0.46 ± 0.16, p=0.0131), and trivial to mild TR and severe mitral regurgitation (MR; 0.61 ± 0.14, p=0.0017) when compared with the normal dogs (0.17 ± 0.10). In addition, the RV Tei index in dogs with TR significantly increased in association with pulmonary hypertension [PH(-), 0.19 ± 0.09; PH(+), 0.65 ± 0.14; respectively p<0.0001]. Our study has demonstrated that RV Tei index is a feasible approach to estimate RV function in dogs and is not influenced by heart rate, body weight, and aging. Right ventricular (RV) function plays an important role in determining cardiac output and functional capacity in humans [1,28]. RV dysfunction has been observed in various cardiac disorders such as pulmonary hypertension (PH) [17,37], idiopathic dilated cardiomyopathy (DCM) [22], and heart failure [7,8,27].RV function can be evaluated by cardiac catheterization with RV peak +/-dP/dt, Tau and RV ejection fraction. However, this method is invasive, and it is difficult to evaluate the RV function due to the complex structural geometry, mechanical properties, and contraction pattern of the right ventricle [12,16].A decade ago, the Tei index (index of myocardial performance) derived from pulsed Doppler echocardiography was proposed in human medicine [36,39]. The Tei index is defined as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), and it has been reported to reflect comprehensive cardiac function, including systolic and diastolic performances, in humans [36,39]. The Tei index is a simple and reproducible technique, and is relatively independent of heart rate [4,39] and age [19]. In addition, the Tei index has been demonstrated to be clinically useful in estimating the prognosis in human patients with primary PH [37,44], DCM [9], cardiac amyloidosis [38], and myocardial infarction [32]. It could be used for evaluating the RV function as well as the left ventricular function that is unrelated to the complex RV geometric structure [10, 11, 19, 24, 33-35, 37, 44].In small animal medicine, RV dysfunction is suspected in dogs with various cardiac diseases such as left-sided heart failure, pulmonary stenosis, tricuspid dysplasia, dirofilariasis, idiopathic cardiomyopathy, cor pulmonale, and idiopathic or secondary PH...

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Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

Teshima

Asano

Iwanaga

et al. 2006

The Journal of Veterinary Medical Science

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“…In our study, we saw increased end systolic RV volumes in the RV dysfunction group which resulted in delay in the latter part of right bundle branch leading to prolonged R' duration. RV dysfunction is implicated in clinical deterioration and cardiovascular mortality (16)(17)(18). Echocardiography is the most commonly used tool for assessment of RV dysfunction.…”

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Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Devarapally

Arora

Ahmad

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Right ventricular (RV) failure has proven to be independently associated with adverse outcomes. Electrocardiographic parameters assessing RV function are largely unknown, making echocardiography the first line for RV function assessment. It is however, limited by geometrical assumptions and is inferior to cardiac magnetic resonance imaging (CMRI) which is widely regarded as the most accurate tool for assessing RV function. Methods:We seek to determine the correlation of ECG parameters of right bundle branch block (RBBB) with RV ejection fraction (EF) and RV dimensions using the CMRI. QRS duration, R amplitude and R' duration were obtained from precordial lead V1; S duration and amplitude were obtained from lead I and AVL. RV systolic dysfunction was defined as RV EF <40%. RV systolic dysfunction group (mean EF of 24±10%) were compared with normal RV systolic function group which acted as control (mean EF of 48±8%). CMRI and ECG parameters were compared between the two groups. Rank correlations and scatter diagrams between individual CMRI parameters and ECG parameters were done using medcalc for windows, version 12.5. Sensitivity, specificity and area under the curve (AUC) were calculated.Results: RV systolic dysfunction group was found to have larger RV end systolic volumes (90±42 vs. 59±40 mL, P=0.02). ECG evaluation of RV dysfunction group revealed longer R' duration (103±22 vs.84±18 msec, P=0.005) as compared to the control group. The specificity of R' duration >100 msec to detect RV systolic dysfunction was found to be 93%. R' duration was found to have an inverse correlation with RV EF (r=−0.49, P=0.007).Conclusions: Larger RV end systolic volumes seen with RV dysfunction can affect the latter part of right bundle branch leading to prolonged R' duration. We here found prolonged R' duration in lead V1 to have a highly specific inverse correlation to RV systolic function. ECG can be used as an inexpensive tool for RV function assessment and should be used alongside echocardiography to evaluate RV dysfunction when CMRI is not available.

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“…2) In previous reports, assessment of right ventricular (RV) function has been shown to be important under several clinical conditions, such as acute pulmonary embolism (PE), valvular diseases, and congenital heart disease, as well as after cardiac surgery. [3][4][5][6] RV dysfunction in patients with left-sided HF has also been shown to be associated with an adverse outcome in a small series of patients with symptomatic HF, but studies of RV systolic function as a risk factor are challenging as a result of a lack of clinically applicable methods for the evaluation of RV performance. [1][2][3][7][8][9][10][11][12][13] Echocardiography remains the mainstay for the diagnosis of a variety of cardiac structural and hemodynamic abnormalities.…”

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Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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SummaryRight ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent longterm outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≧ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters. (Int Heart J 2011; 52: 119-126)

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Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy

Abstract: In addition to left ventricular ejection fraction, right ventricular ejection fraction appears to be a complementary predictor of survival in idiopathic dilated cardiomyopathy, suggesting the importance of assessing right ventricular function in this disease.

Cited by 262 publications

References 27 publications

Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

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