Prevalence, functional characteristics, and clinical significance of right ventricular involvement in patients with hypertrophic cardiomyopathy

Abstract

We sought to investigate the prevalence, functional characteristics, and clinical significance of right ventricular (RV) involvement in patients with hypertrophic cardiomyopathy (HCM). A total of 256 patients with HCM who underwent both cardiac magnetic resonance (CMR) imaging and transthoracic echocardiography within 6 months of each other were retrospectively analysed. RV involvement was defined as an increased RV wall thickness ≥ 7 mm on CMR in the segments of the RV free wall. Primary outcomes were defined as the composite of all-cause death, heart transplantation, and unplanned cardiovascular admission. Thirty-seven (14.4%) patients showed RV involvement. Patients with RV involvement showed a significantly higher left ventricular (LV) maximal wall thickness and left atrial volume index. Multivariate Cox model revealed that RV involvement was independently associated with primary outcomes (HR: 2.30, p = 0.024). In a subgroup analysis of patients with speckle tracking echocardiography (n = 190), those with RV involvement had significantly more impaired RV strain, which was independently associated with primary outcomes. RV involvement in patients with HCM correlated with more advanced LV structure and biventricular dysfunction, suggesting an indicator of severe HCM. RV involvement and impaired RV strain have a prognostic value related to clinical adverse events in patients with HCM.

Right-ventricular mechanics assessed by cardiovascular magnetic resonance feature tracking in children with hypertrophic cardiomyopathy

“…Moreover, Badaran et al used vector velocity imaging and showed severe displacement incorrectness at all levels of RV in HCM adults [ 22 ]. Our study is the first to demonstrate an impairment of RV mechanics in the childhood HCM population by means of CMR-FT. Our results of CMR-FT-derived RVGLS are slightly higher than the values obtained with echocardiography in adults [ 29 ]. Interestingly, in the study by Cincin et al, unlike in our study, LVOT obstruction in HCM was not associated with the impairment of RV mechanics [ 28 ].…”

Echocardiographic evaluation of hypertrophic cardiomyopathy: A review of up‐to‐date knowledge and practical tips

“…Assessment of RV systolic function: Patients with RV involvement had more impaired LV global LS, RV global LS, RV septal wall LS, and RV free wall LS than those without RV involvement. RV global LS ( R = .345, P < 0.001) and RV free wall LS ( R = .310, P < 0.001) were significantly correlated with RV maximal WT 45 …”

“…Pressure across RVOT is measured in parasternal short axis or parasternal RV outflow view. Mid‐base obstruction in the RV is characterized by a prominent hypertrophied septal band. Doppler signal appears relatively symmetric and dome‐like and not dagger‐shaped like LVOT obstruction. Assessment of RV systolic function: Patients with RV involvement had more impaired LV global LS, RV global LS, RV septal wall LS, and RV free wall LS than those without RV involvement. RV global LS ( R = .345, P < 0.001) and RV free wall LS ( R = .310, P < 0.001) were significantly correlated with RV maximal WT 45 The RV E/A ratio is lower and the RV isovolumetric relaxation time and RV deceleration time are significantly prolonged in patients with HCM 43 …”

“…RV global LS (R = .345, P < 0.001) and RV free wall LS (R = .310, P < 0.001) were significantly correlated with RV maximal WT. 45 5. The RV E/A ratio is lower and the RV isovolumetric relaxation time and RV deceleration time are significantly prolonged in patients with HCM.…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…RV strain assessment was shown to be feasible and biventricular involvement indicated by an impaired RV strain was associated with adverse outcome in HCM patients [70,71]. With HCM not only affecting ventricular morphology but also inducing atrial enlargement, especially LA function and abnormalities have been shown to characterise different stages of the disease.…”