Right ventricular dysfunction in patients with idiopathic dilated cardiomyopathy: Prognostic value and predictive factors

Background. - Right ventricular (RV) dysfunction is an important predictor of impaired prognosis in idiopathic dilated cardiomyopathy. Aims. To determine the prognostic role of RV dysfunction, independent of left ventricular (LV) dysfunction. Methods. - A total of 136 consecutive patients (73% men; mean age 59.0 +/- 13.2 years) with idiopathic dilated cardiomyopathy (LV ejection fraction <= 45%) were enrolled retrospectively. Thirty-four patients (25%, group 1) presented with RV dysfunction, defined as tricuspid annular plane systolic excursion (TAPSE) <= 15 mm; 102 patients (group 2) had preserved RV function. Results. - Mean LV ejection fraction was 27.5 +/- 8.7%. Mean TAPSE was 18.6 +/- 5.4 mm (15-21.8 mm). Multivariable predictors of RV dysfunction were LV outflow tract time-velocity integral (odds ratio 0.8, 95% confidence interval [CI] 0.7-0.9; P=0.003) and E-wave deceleration time <= 145 ms (odds ratio 4:1, 95% CI 1.3-12.8; P=0.017). Major adverse cardiac event -free survival rates at 1 and 2 years were 64% and 55%, respectively, in group 1 and 87% and 79%, respectively, in group 2 (P=0.002). Both by multivariable analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictor for major adverse cardiac events (hazard ratio 3.2, 95% CI 1.3-7.6; P=0.009), along with right atrium area and age. Conclusion. - In idiopathic dilated cardiomyopathy, RV dysfunction with TAPSE <15 mm offers additional prognostic information, independent of the extent of LV dysfunction. (C) 2015 Elsevier Masson SAS. All rights reserved.