Phenotypic Patterns of Right Ventricular Dysfunction. Analysis by Cardiac Magnetic Resonance Imaging

Abstract

Objectives: To classify by magnetic resonance imaging (MRI) the morphological changes and remodeling of the right ventricle (RV) that occur in the different clinical scenarios that have impact on this ventricle. Background: Most of the scientific evidence in cardiology has traditionally focused on the left ventricle (LV). As a result, there are few studies focusing on the analysis of RV behavior and remodeling. Methods: This was a descriptive study evaluating all cardiac MRI exams performed at our center from 2008 to 2010. We retrospectively identified 159 patients who had some sign of right ventricular dysfunction (RVD) based on MRI findings. We classified patients based on a combination of criteria for RVD and the presence of left ventricle dysfunction (LVD). We considered RVD as any of the following abnormalities: 1) Depressed RV function; 2) RV dilatation; 3) RV hypertrophy. LVD was considered when there was atrial dilatation, LV hypertrophy, LV dilatation and/or depressed LV function. Results: We obtained 6 pathophysiologic patterns: RV pressure overload (1.9%), RV volume overload (15.7%), RV volume overload + LVD (32.7%), depressed RV function + LVD (42.1%), mixed RV overload + LVD (6.9%) and other (0.6%). By etiologies, the most frequent etiology was congenital heart disease (33.3%), followed by idiopathic dilated cardiomyopathy (18.2%), left valvular disease (17.6%), ischemic heart disease (15%), pulmonary disease (9.8%), and other (6.1%). Conclusions: This study helps to classify the different patterns that the RV can adopt in different clinical scenarios and thus help us to understand the pathophysiology of the RV