It 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 [
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022;79:e263-e421.
2
,
3
,
4
,
5
]. Benefits have, of course, been observed in systolic heart failure with ischemic
etiologies, who at baseline, have increased risk of adverse arrythmogenic events resulting
from areas of ischemia-induced pro-arrhythmogenic patches of fibrotic tissue [
[4]
]. Interestingly, however, in similar population of patients with NICM and heart failure
(HF), RV function as assessed by ejection fraction on cardiovascular magnetic resonance
has an independent association with arrhythmic events [
[6]
]. From this apparent contradiction arises the possibility that RV dysfunction itself
may contribute to ventricular arrhythmia in unknown ways or patients with biventricular
dysfunction disproportionately suffer from ventricular arrhythmia. These findings
suggest that the utilization of measures of RV dysfunction as imaging biomarkers to
identify which subsets of systolic heart failure patients would directly benefit from
ICD implantation may result in a mortality benefit.- Mikami Y
- Jolly U
- Heydari B
- Peng M
- Almehmadi F
- Zahrani M
- et al.
Right ventricular ejection fraction is incremental to left ventricular ejection fraction
for the prediction of future arrhythmic events in patients with systolic dysfunction.
Circulation: Arrhythmia and Electrophysiology. 2017; 10e004067
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REFERENCES
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022;79:e263-e421.
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- Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT).Circulation. 2002; 105: 1453-1458
- Right ventricular ejection fraction is incremental to left ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction.Circulation: Arrhythmia and Electrophysiology. 2017; 10e004067
- Right ventricular free wall strain and effect of defibrillator implantation in patients with non-ischemic systolic heart failure.Journal of Cardiac Failure. 2023;
- Right ventricular dysfunction and the effect of defibrillator implantation in patients with nonischemic systolic heart failure.Circulation: Arrhythmia and Electrophysiology. 2019; 12e007022
- The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy.Circulation. 2013; 128: 1623-1633
- The prevalence, correlates, and impact on cardiac mortality of right ventricular dysfunction in nonischemic cardiomyopathy.JACC: Cardiovascular Imaging. 2017; 10: 1225-1236
- 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: Cardiovascular Imaging. 2019; 12: 2373-2385
Article info
Publication history
Accepted:
February 21,
2023
Received:
February 21,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures and Funding: AHA 23PRE1026275 (VJ). NIH/NHLBI R01HL162851 (MM).
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
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- Right Ventricular Free Wall Strain and Effect of Defibrillator Implantation in Patients With Nonischemic Systolic Heart FailureJournal of Cardiac Failure
- PreviewPatients 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.
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