Abstract
Background
Patients with nonischemic systolic heart failure have an increased risk of malignant
ventricular arrhythmias and sudden cardiovascular death. Because the risk is less
pronounced than for patients with ischemic cause of heart failure more discriminating
tools are needed to identify patients most likely to benefit from implantable cardioverter-defibrillator
(ICD) implantation. Right ventricular (RV) dysfunction is associated with a worse
prognosis, but whether RV free wall strain (RV-FWS) measured with echocardiography
can identify the patients most likely to benefit from ICD implantation is not known.
Methods and Results
In this extended follow-up analysis of the Danish Study to Assess the Efficacy of
ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial,
RV-FWS was measured with echocardiography in 445 patients before randomization. RV
dysfunction was defined as an RV-FWS of greater than –20%. The primary end point was
all-cause mortality. The median RV-FWS was –18% (quartiles –23% to –14%), and RV dysfunction
was measured in 255 patients (57%). During a median follow-up of 5.7 years, 170 patients
(38%) died. There was a statistically significant interaction between RV dysfunction
and the effect of ICD implantation (P = .003), also after adjusting for known cardiovascular risk factors (P = .01). ICD implantation significantly decreased all-cause mortality in patients
with RV dysfunction (hazard ratio 0.54, 95% confidence interval 0.36-0.80, P = .002), but not in patients with normal RV function (hazard ratio 1.34, 95% confidence
interval 0.84-2.12, P = .22).
Conclusions
In patients with nonischemic systolic heart failure, RV dysfunction on echocardiography
was associated with a greater effect of ICD implantation and could be used to select
patients with benefit from ICD treatment.
Graphical Abstract
Graphical Abstract
Key Words
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References
- Heart disease and stroke statistics—2020 update: a report from the American Heart Association.Circulation. 2020; 141: e139-e596
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
- Effectiveness of implantation of cardioverter-defibrillators therapy in patients with non-ischemic heart failure: an updated systematic review and meta-analysis.Braz J Cardiovasc Surg. 2017; 32: 417-422
- Defibrillator implantation in patients with nonischemic systolic heart failure.N Engl J Med. 2016; 375: 1221-1230
- Right ventricular ejection fraction is incremental to left ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction.Circ Arrhythm Electrophysiol. 2017; 10e004067
- Right ventricular dysfunction and long-term risk of sudden cardiac death in patients with and without severe left ventricular dysfunction.Circ Arrhythm Electrophysiol. 2018; 11e006091
- The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy.Circulation. 2013; 128: 1623-1633
- Right ventricular dysfunction and the effect of defibrillator implantation in patients with nonischemic systolic heart failure.Circ Arrhythm Electrophysiol. 2019; 12e007022
- New directions in right ventricular assessment using 3-dimensional echocardiography.JAMA Cardiol. 2019; 4: 936
- Additional prognostic value of 2D right ventricular speckle-tracking strain for prediction of survival in heart failure and reduced ejection fraction.JACC Cardiovasc Imaging. 2019; 12: 2373-2385
- Rationale, design, and baseline characteristics of the DANish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillators in patients with non-ischemic Systolic Heart failure on mortality (DANISH).Am Heart J. 2016; 179: 136-141
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39.e14
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.Eur Heart J Cardiovasc Imaging. 2015; 16: 233-271
- Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction.Am Heart J. 2001; 142: 181-189
- Right ventricular dysfunction, late gadolinium enhancement, and female gender predict poor outcome in patients with dilated cardiomyopathy.Int J Cardiol. 2014; 177: 429-435
- Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure.Eur J Heart Fail. 2007; 9: 610-616
- Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure.J Am Coll Cardiol. 1998; 32: 948-954
- The prevalence, correlates, and impact on cardiac mortality of right ventricular dysfunction in nonischemic cardiomyopathy.JACC Cardiovasc Imaging. 2017; 10: 1225-1236
- Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy.Eur Heart J. 1997; 18: 276-280
- High prevalence of right ventricular dysfunction in ICD patients with shocks: a potential new predictor in risk stratification.J Interv Card Electrophysiol Int J Arrhythm Pacing. 2011; 31: 165-169
- Right ventricle dysfunction in cardiomyopathy: to measure is to know.JACC Cardiovasc Imaging. 2017; 10: 1237-1239
- Additional prognostic value of 2D right ventricular speckle-tracking strain for prediction of survival in heart failure and reduced ejection fraction: a comparative study with cardiac magnetic resonance.JACC Cardiovasc Imaging. 2019; 12: 2373-2385
- An explainable machine learning approach reveals prognostic significance of right ventricular dysfunction in nonischemic cardiomyopathy.JACC Cardiovasc Imaging. 2022; 15 (S1936-878X(21)00902–5): 766-779
- The prognostic value of right ventricular long axis strain in non-ischaemic dilated cardiomyopathies using standard cardiac magnetic resonance imaging.Eur Radiol. 2017; 27: 3913-3923
- Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles.J Magn Reson Imaging. 2008; 28: 67-73
- Characteristics and prognostic value of right ventricular (dys)function in patients with non-ischaemic dilated cardiomyopathy assessed with cardiac magnetic resonance imaging.ESC Heart Fail. 2021; 8: 1055-1063
- Right ventricular function in cardiovascular disease, part i: anatomy, physiology, aging, and functional assessment of the right ventricle.Circulation. 2008; 117: 1436-1448
Article info
Publication history
Published online: January 25, 2023
Accepted:
December 21,
2022
Received in revised form:
December 20,
2022
Received:
September 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
ScienceDirect
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- Forgotten No More, The People's Ventricle Has SpokenJournal of Cardiac Failure
- PreviewIt has long been known that the presence of right ventricular (RV) dysfunction in patients with heart failure and reduced systolic function is a key prognosticator of worsened prognosis and mortality [1]. Less widely known, however, is whether the imaging biomarkers of RV dysfunction can be used for more targeted and effective use of heart failure therapies. For instance, in non-ischemic cardiomyopathy (NICM), studies have shown no benefit for secondary prevention implantable cardio-defibrillator (ICD) implantation for all-cause mortality and sudden cardiac death [2–5].
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