Predictors and Prognostic Significance of Right Ventricular Ejection Fraction in Patients with Ischemic Cardiomyopathy
Background—Decreased right ventricular ejection fraction (RVEF) portends poor prognosis in patients with ischemic cardiomyopathy and previous studies have suggested an association between mitral regurgitation (MR) and RVEF. We sought to evaluate this association as well as whether mitral valve repair or replacement (MVrR) affects the relationship between RV function and mortality.
Methods—We included 588 patients (mean age 63 +/- 11 yr; 75% male) with ischemic cardiomyopathy who underwent cardiac MRI between 2002-2008. Baseline characteristics, left ventricular ejection fraction (LVEF), MR severity, treatment modality, scar burden, and RVEF were assessed. Multivariable linear regression and Cox proportional hazards models were used to assess the association between MR and RVEF and RVEF and mortality, respectively.
Results—After adjusting for age, gender, LVEF, right bundle branch block (RBBB), and RV scar, MR severity was found to be independently associated with RVEF. There were a total of 240 deaths over a median follow-up time of 5.7 years. After multivariable adjustment, every 10% decrease in RVEF was associated with a 17% increased risk of death (p=0.008). Although decreasing RVEF was associated with a poor prognosis in the non-repair group (HR 1.28 [1.12-1.47], p<0.001), it was not associated with death in the MVrR group (p for interaction 0.046).
Conclusions—MR severity was found to be an independent predictor of RVEF, as were RBBB, LVEF, and the presence of RV scar. Decreasing RVEF is associated with increased mortality in patients with ischemic cardiomyopathy; however this association may be mitigated in patients who undergo MVrR.
- magnetic resonance imaging
- mitral regurgitation
- ischemic cardiomyopathy
- right ventricle infarction
- right ventricle
- Received March 9, 2016.
- Revision received June 24, 2016.
- Accepted July 8, 2016.