Abstract
Abstract Background Prognostic value of right ventricular (RV) ejection fraction (EF) using three-dimensional echocardiography (3DE) in a diverse group of patients has been demonstrated in several studies [1-3]. However, little is known about its potential utility in patients with ischaemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM). Purpose To investigate the prognostic value of 3DE-RVEF in ICM and DCM. Methods We retrospectively selected ICM and DCM patients who had undergone 3DE from December 2007 to December 2018. 3DE analysis was performed using 3DE speckle tracking software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia. Results 268 ICM and 127 DCM patients were included in this analysis. During a median of 33 and 51 months of follow-up, 84 and 43 patients reached a primary end point in ICM and DCM, respectively. Univariable analysis showed RVEF was significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.90 – 0.94; DCM, HR: 0.91, 95% CI: 0.88 – 0.94, respectively]. In multivariable analysis, RVEF (HR: 0.91, both for p<0.001) was significantly associated with cardiac events, after adjustment for age, chronic kidney disease, New York Heart Association function class (NYHA), Charlson comorbidity index (CCI), E/e', left ventricular (LV) EF or LV global longitudinal strain (GLS) in ICM. In DCM, RVEF (HR: 0.91 – 0.94, all for p<0.001) was significantly associated with outcome, after adjusting clinical factors (age and CCI or NYHA) and echocardiographic parameters (E/e' or LVEF or LVGLS). Kaplan-Meier survival curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e' 14 ≥ and < 14, showed significant risk stratification for both ICM and DCM (Log-rank: p<0.0001, Fig 1). Crude Kaplan-Meyer survival analysis revealed there were no significant survival differences between ICM and DCM (p=0.36). However, ICM had a worse outcome than DCM after adjustment for age, NYHA, CCI, E/e', RVEF, LVEF or LVGLS (p=0.049 and p=0.028, respectively, Fig 2). Conclusions Our study confirmed the independent prognostic value of RVEF in patients with ICM and DCM and provided detailed risk stratification of cardiac events by E/e' and RVEF. In addition, ICM was associated with worse outcome than DCM after adjusting multiple covariates.
Published Version
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