J. Urmeneta Ulloa, E. Pozo Osinalde, J. A. Cabrera, M. Recio Rodríguez, I. J. Thuissard-Vasallo, C. Andreu-Vázquez, F. Islas, L. Pérez de Isla, P. Marcos-Alberca, P. Mahía, M. A. Cobos, B. Cabeza, J. L. Rodríguez-Hernández, M. Luaces Méndez, J. J. Gómez de Diego, A. Bustos, J. Pérez-Villacastín, A. de Agustín & V. Martínez de Vega.
BMC Cardiovascular Disorders volume 23, Article number: 13 (2023)
Abstract
Background
Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker.
Methods
Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model.
Results
98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (−21.6 ± 6.6% vs −31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%.
Conclusions
In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.
Fig 1. RV free wall tracking feature using CMR. On the left, example of patient with impaired RV dysfunction, decreased LFT-RVFW and FAC. On the right, patient with preserved RV contractile function, normal LFT-RVFW and FAC. LFT-RVFW longitudinal feature tracking-right ventricular free wall, FAC fractional area change, RV right ventricle.