Right ventricular function declines prior to left ventricular ejection fraction in hypertrophic cardiomyopathy

Abstract

Background The right ventricle (RV) in hypertrophic cardiomyopathy (HCM) tends to be neglected, as previous efforts have predominantly focused on examining the prognostic value of left ventricular (LV) abnormalities. The objectives of this study were to assess RV function in HCM, changes over time, and association with clinical outcomes. Methods Two hundred and ninety HCM patients with preserved LV ejection fraction (LVEF ≥ 55%) and 30 age- and sex-matched controls underwent cardiovascular magnetic resonance (CMR). All patients were followed up for clinical events for a median duration of 4.4 years. Sixty-three patients had a follow-up CMR undertaken at a median interval of 5.4 years. Main study measures and outcomes were RV function (RV ejection fraction (RVEF) and RV strain) at baseline, temporal changes in RV function over time and prognostic value of RV dysfunction for predicting cardiovascular outcomes in HCM. Results When compared to controls, HCM patients exhibited lower RV and LV peak global longitudinal systolic strains on feature-tracking analysis of cine images, while RVEF and LVEF were within the normal range. On follow-up CMR, both RV and LV strain parameters decreased over time. RVEF decreased at follow-up (65 ± 7% to 62 ± 7%, P < 0.001) but the change in LVEF was not significant (68 ± 10% to 66 ± 8%, P = 0.30). On clinical follow up, reduced RVEF was an independent predictor of non-sustained ventricular tachycardia (NSVT) [HR 1.10 (95% CI 1.06–1.15), P < 0.001] and composite cardiovascular events (NSVT, stroke, heart failure hospitalisation and cardiovascular death) [HR 1.07 (95% CI 1.03–1.10), P < 0.001]. RV longitudinal strain was an independent predictor of NSVT [HR 1.05 (95% CI 1.01–1.09), P = 0.029]. Patients with RVEF < 55% showed an increased risk of NSVT and composite cardiovascular events. In contrast, LVEF and LV global longitudinal strain were not predictive of such events on multivariable analysis. Conclusions In HCM, RV function, including RV strain, and LV strain decrease over time despite preserved LVEF. Reduction in RV but not LV function is associated with adverse cardiovascular outcomes. Assessing RV function in early HCM disease might have a role in risk stratification to prevent future cardiovascular events.

Left ventricular strain patterns and their relationships with cardiac biomarkers in hypertrophic cardiomyopathy patients with preserved left ventricular ejection fraction

“…First, this study focused on HCM with preserved LVEF in hospitalized patients. Therefore, the percentage of HCM patients with LGE (82.81%) and LVOTO (65.63%) was high compared with a prior study that focused on all HCM patients with preserved LVEF ( 16 ). Such an approach helped us learn more accurately about more serious HCM patients of this subtype, thus promoting their clinical management.…”

Prognostic Value of Cardiac Magnetic Resonance in Assessing Right Ventricular Strain in Cardiovascular Disease: A Systematic Review and Meta-Analysis

“…Such changes have significantly higher predictive values than conventional parameters. For example, Mahmod et al [22] found that both RV and LV strain were impaired in patients with HCM despite normal LVEFd. A small decrease was observed in RVEF, but it was within the acceptable normal range.…”

“…The information obtained from CMR is presented in Table 2 (Ref. [2,[10][11][12][13][14][15][16][17][18][19][20][21][22]). Our study included ten prospective studies [2,[10][11][12]14,15,[18][19][20][21] and four retrospective studies [13,16,17,22].…”

“…Moreover, specific diseases were not studied and distinguished, which resulted in a large heterogeneity. Mahmod et al [22] defined composite cardiovascular events as non-sustained ventricular tachycardia (NSVT), stroke, HF hospitalisation and cardiovascular death. This definition might have affected the final conclusion because there were multiple outcome events.…”

“…This definition might have affected the final conclusion because there were multiple outcome events. Furthermore, Mahmod et al [22] demonstrated that strain in the right ventricle is of great value in predicting the development of NSVT. However, these studies [16,22] were included in the meta-analysis because of the predictive value of right ventricular strain in its find-ings.…”