Abstract 693: Right Ventricular Dilation in Patients with Mild and Moderate Heart Failure: Implications in Morbidity and Mortality

Abstract

Objectives: To investigate the prognostic impact of right ventricular (RV) morphology in patients with mild and moderate heart failure. Methods: 80 normal subjects and 401 consecutive patients with left ventricular (LV) ejection fraction (EF)< 45%, on optimal treatment, underwent cardiac magnetic resonance imaging (C-MRI). The LV and the RV borders were detected from the short axis contiguous slices and drawn manually. Body surface area was used to index (I) the LV and RV mass (M) and volumes (V) measured at end-diastole (ED) and end-systole (ES). The indexed volumes were then used to calculate the LV and RV EF. RV dilatation was defined as mean RVESVI+2*SD in normal subjects. Results: 21 patients had incomplete data and excluded from the analysis. The median age for the remaining patients was 71 years and 86% were men. 77% had ischaemic heart disease and 78% had NYHA I/II breathlessness. The median LVEF was 33% and the RVEF 43%. 286 (75%) patients had normal and 94 (25%) dilated RV. Patients with RV dilation were more often male (92% vs. 84%, p=0.036), had lower systolic blood pressure (120mmHg vs. 129mmHg, p=0.003), and were more likely to have NYHA breathlessness III/IV (30% vs. 18%, p=0.006). Patients with normal RV had higher LVEF (34% vs. 31%, p=0.015), smaller LVEDVI (115ml/m 2 vs. 137ml/m 2 , p<0.0001) and LVESVI (77ml/m 2 vs. 92ml/m 2 , p<0.0001) and were more likely to tolerate β-blockers (91% vs. 74%, p=0.002). Patients were followed up for 45±22months. During that time, there were no significant differences between the two groups regarding the reasons for admissions and the time that they spent to the hospital. Within that time 108 patients died [35 (37%) with dilated and 69 (24%) with normal RV; log-rank=8.404, p=0.004]. In multivariable Cox regression model, including 15 variables only increasing RVESVI (HR: 1.009, 95%CI: 1.000–1.017; p=0.043), the presence of ischaemic heart disease (HR: 2.186, 95%CI: 1.049–4.557; p=0.037) and the presence of peripheral vascular disease (HR: 1.674, 95%CI: 1.036–2.705; p=0.037) were independent predictors of mortality but not LVESVI. Conclusions: RV dilation is a common finding in patients with mild and moderate heart failure and is associated with worse prognosis.