Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction

Naksuk, Niyada; Tan, Nicholas; Padmanabhan, Deepak; Kancharla, Krishna; Makkar, Nayani; Yogeswaran, Vidhushei; Kaginele, Pranita; Riley, David C.; Sugrue, Alan; Rosenbaum, Andrew; El‐Harasis, Majd A.; Asirvatham, Samuel J.; Kapa, Suraj; McLeod, Christopher J.

doi:10.1161/circep.117.006091

Cited by 40 publications

(24 citation statements)

References 44 publications

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“…Risum et al 23 found that RV free-wall strain as measured by 2-dimensional echocardiographic analysis was significantly associated with ventricular arrhythmias/SCD and superior as a predictor compared to TAPSE in an acute myocardial infarction population. In one of the largest studies to date of 5463 subjects who all had been admitted to the coronary care unit at Mayo Clinic, Rochester, Minnesota, Naksuk et al 24 found that moderate to severe RV dysfunction as determined jointly by TAPSE, RV index of myocardial performance, and tricuspid annular S 0 wave velocity was an incremental predictor of SCD in both patients with LVEF 35% and those with LVEF .35%. These studies all indicate that RV dysfunction by various means of assessment can be predictive of SCD risk.…”

Section: Discussionmentioning

confidence: 99%

An association between right ventricular dysfunction and sudden cardiac death

et al. 2020

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BACKGROUND The effectiveness of severely reduced left ventricular ejection fraction (LVEF ,35%) as a predictor of sudden cardiac death (SCD) has diminished, and improvements in risk stratification await discovery of novel markers. Right ventricular (RV) abnormalities can be observed in conditions such as chronic obstructive pulmonary disease and sleep apnea, which have been linked to SCD.OBJECTIVE The purpose of this study was to evaluate whether RV abnormalities were associated with SCD after accounting for LVEF and other patient characteristics.METHODS In a large, prospective ongoing community-based study of SCD in the Portland, Oregon, metropolitan area, SCD cases (age 18 years; 2002-2014) were compared to controls with coronary artery disease but no SCD. Using a novel archive of digital echocardiograms, a standardized approach was used to evaluate RV basal diameter, RV end-diastolic area, and right ventricular fractional area change (RVFAC). RESULTSA total of 350 subjects were studied, including 81 SCD cases (age 68.7 6 13.6 years; 73% male) and 269 controls (age 66.5 6 10.2 years; 69% male). In multivariate analysis, RVFAC was significantly associated with SCD (odds ratio 1.14 for each 5% decrease; 95% confidence interval 1.03-1.25; P 5 .01). When modeled with LVEF 35%, RVFAC 35% was significantly associated with increased risk of SCD. Individuals with both left ventricular and RV dysfunction had a 3! higher odds of SCD than those with neither (odds ratio 3.19; 95% confidence interval 1.33-7.68; P 5 .01).CONCLUSION RV dysfunction was associated with a significantly increased risk of SCD independent of LVEF and, when combined with LVEF, had additive effects on SCD risk.

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Section: Discussionmentioning

confidence: 99%

An association between right ventricular dysfunction and sudden cardiac death

et al. 2020

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“…Right ventricular dysfunction, detected by echocardiogram, with or without concomitant left ventricular dysfunction is a long‐term risk for SCD . The presence of moderate to severe right ventricular dysfunction doubles the hazard of SCD …”

Section: Functional Abnormalitiesmentioning

confidence: 99%

“…19 The presence of moderate to severe right ventricular dysfunction doubles the hazard of SCD. 20 In summary, left ventricular ejection fraction is the most widely used prognostic marker to predict sudden cardiac death and is also the primary marker for formulating therapeutic strategies. However, other echocardiographically derived determinants of structural and functional abnormalities beyond LV EF are important in risk stratification for sudden cardiac death.…”

Section: Fun C Tional Ab Normalitie Smentioning

confidence: 99%

Value of echocardiogram in predicting sudden cardiac death: A look beyond ejection fraction

Koshy

George

2019

Echocardiography

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“…Importantly, new insights show that although the RV consists of, at first glance, the same cardiomyocytes as the LV, it is in fact derived from a different set of precursor cells, with complex three-dimensional anatomy and a very distinct contraction pattern [8]. Recent studies further sparked this renewed interest, showing that RV function is an important predictor of survival in patients with heart failure (HF), PAH, and CHD [9][10][11]. Nevertheless, profound knowledge of normal loading conditions and physiological adaptations ensuing morphology of the RV remains limited [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Right ventricular phenotype, function, and failure: a journey from evolution to clinics

et al. 2020

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The right ventricle has long been perceived as the "low pressure bystander" of the left ventricle. Although the structure consists of, at first glance, the same cardiomyocytes as the left ventricle, it is in fact derived from a different set of precursor cells and has a complex three-dimensional anatomy and a very distinct contraction pattern. Mechanisms of right ventricular failure, its detection and follow-up, and more specific different responses to pressure versus volume overload are still incompletely understood. In order to fully comprehend right ventricular form and function, evolutionary biological entities that have led to the specifics of right ventricular physiology and morphology need to be addressed. Processes responsible for cardiac formation are based on very ancient cardiac lineages and within the first few weeks of fetal life, the human heart seems to repeat cardiac evolution. Furthermore, it appears that most cardiogenic signal pathways (if not all) act in combination with tissue-specific transcriptional cofactors to exert inductive responses reflecting an important expansion of ancestral regulatory genes throughout evolution and eventually cardiac complexity. Such molecular entities result in specific biomechanics of the RV that differs from that of the left ventricle. It is clear that sole descriptions of right ventricular contraction patterns (and LV contraction patterns for that matter) are futile and need to be addressed into a bigger multilayer three-dimensional picture. Therefore, we aim to present a complete picture from evolution, formation, and clinical presentation of right ventricular (mal)adaptation and failure on a molecular, cellular, biomechanical, and (patho)anatomical basis.

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Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction

Abstract: Presence of RVD in patients with a history of preexisting cardiac disease is an independent predictor of SCD irrespective of left ventricular ejection fraction.

Cited by 40 publications

References 44 publications

An association between right ventricular dysfunction and sudden cardiac death

An association between right ventricular dysfunction and sudden cardiac death

Value of echocardiogram in predicting sudden cardiac death: A look beyond ejection fraction

Right ventricular phenotype, function, and failure: a journey from evolution to clinics

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