Abstract 15658: Prognostic Value of Right Ventricular Dilation and Dysfunction in Patients With Ischemic Cardiomyopathy: Impact of Revascularization
Background: Right ventricular dysfunction has been shown to be a strong predictor of mortality in patients with ischemic cardiomyopathy. Whether this association is affected by revascularization has not been previously studied.
Methods: We retrospectively evaluated 218 consecutive patients with ischemic cardiomyopathy who were referred for cardiac MRI between 2005-2008. Baseline characteristics, LV function, post-MRI treatment modality, scar burden, and RV volumes and function were assessed. The association of RV volume and function with mortality was examined using survival analysis.
Results: We studied 218 patients (mean age 62 +/- 11.5 years, 80% male). There were 79 deaths over a mean follow-up time of 5.0±2.6 years. 123 (56%) patients underwent subsequent revascularization (CABG or PCI) and 95 (44%) were medically managed. There was no significant difference in age, sex, history of diabetes, hypertension, hyperlipidemia, RVEF, or RVESVI between the two groups. Mean LVEF was 29% in the medical group and 24% in the revascularization group (p = 0.002). On multivariate analysis, after adjusting for age, sex, LVEF, scar burden, and MR severity, RVESVi emerged as an independent predictor of mortality (HR 1.01 [1.001-1.019], p = 0.025) while increasing RVEF demonstrated a non-significant trend towards decreased mortality (HR 0.98 [0.966-1.001] p = 0.064). Upon dividing the population based on treatment strategy (subsequent revascularization vs medical treatment), higher RVESVi and lower RVEF were significant predictors only in the medically managed group (HR 1.02 [1.01-1.04] p = 0.001 and HR 0.97 [0.94-0.99] p = 0.007, respectively), while these parameters were not associated with risk in the revascularized patients. See Fig 1.
Conclusions: Right ventricular dilation and dysfunction are associated with mortality in patients with ischemic cardiomyopathy, however this association appears to be mitigated in patients who undergo revascularization.
- © 2013 by American Heart Association, Inc.