Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy

Abstract

hronic heart failure (CHF) has emerged as the most prevalent cause of mortality, morbidity and hospitalization in industrialized countries over the past years. 1 Despite the advances in medical and invasive treatment of CHF, its incidence is expected to rise in the future because of improved survival rates following acute myocardial infarction (MI), which is the principal etiology of CHF in >70% of patients. 2 Traditionally, great emphasis was put on evaluation of the various etiologic factors of this syndrome. Differentiation between ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (DCM) has important therapeutic implications because the former may gain substantial benefit from coronary revascularization. 3 Conventional echocardiography is commonly used for the evaluation of left ventricular (LV) and right ventricular (RV) function, but does not provide detailed information about myocardial systolic and diastolic properties in the regional segments. Tissue Doppler echocardiography (TDE) is a promising ultrasonographic technique that quantitatively measures the velocity of the myocardium in systole and diastole. 4 Traditionally, the principal target of the cardiologist is the evaluation of the LV function, with little interest in the RV. In spite of the fact that several recent studies have used the TDE technique in the assessment of RV function in various clinical conditions, 5,6 the literature on the RV and its impact on the pathophysiologic processes is limited. However, there is a growing body of evidence that RV function is a powerful predictor of mortality in patients with CHF. 7 We hypothesized that ICM and DCM differ in terms of RV function. Thus, the aim of our study was to investigate the RV function in patients with ICM and DCM using pulsed wave TDE and to compare the TDE parameters of the RV among the patients with ischemic and idiopathic dilated causes of LV dysfunction. Methods Study PopulationWe prospectively studied 82 consecutive patients with CHF who had undergone an echocardiographic examination at the AHEPA Hospital (Thessaloniki, Greece). CHF was defined as the presence of heart failure symptoms plus a dilated (>55 mm in end-diastolic diameter) LV with a depressed (<40%) ejection fraction of uncertain origin. The inclusion criteria were: (a) good quality echocardiographic imaging of tricuspid and mitral annular motion, (b) adequate tricuspid valve regurgitation Doppler signal in order to assess pulmonary artery systolic pressure, (c) sinus rhythm on electrocardiography (ECG), and (d) stable clinical condition. The following were considered as exclusion criteria:

Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle*

“…In another study, the same team established the prognostic importance of this parameter in patients with symptomatic heart failure (20). These results were subsequently confirmed by other studies (9,21). Care should be taken when measuring Sta as the sampling gate can intercept the atrial wall or the basal RV wall.…”

Different prognostic impact of the tissue Doppler-derived E/e′ ratio on mortality in Chagas cardiomyopathy patients with heart failure

“…9 Previous studies have shown that decreased RVEF is more predominant in heart failure due to idiopathic dilated cardiomyopathy than in ischemic cardiomyopathy. 31,32 Our study found an association between LV and RV function, as demonstrated by the correlation between LVEF and RVMPI. RV dysfunction may be a consequence of more extensive biventricular involvement of the primary pathologic process (myocardial fibrosis and myofibrillar loss), independent of pulmonary hypertension.…”

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

“…The causes of death could not be identified. RV dysfunction was not quantified, 25 but analyzed qualitatively, which may be subjective, even though it was determined by echocardiography experts. Another limitation of the present study was that the number of patients who underwent TV surgery was too small compared with that of the medical group in our cohort to draw a conclusion about surgical benefits.…”