Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

Eur Heart J Cardiovasc Imaging. 2023 Mar 21;24(4):472-482. doi: 10.1093/ehjci/jeac124.


Aims: Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF).

Methods and results: Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan-Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560-1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09-1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function.

Conclusion: RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.

Keywords: cardiac magnetic resonance; ejection fraction; heart failure; heart failure hospitalization; right ventricular dysfunction.

MeSH terms

  • Aged
  • Cardiomyopathies* / complications
  • Defibrillators, Implantable* / adverse effects
  • Female
  • Heart Failure* / complications
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / therapy
  • Humans
  • Magnetic Resonance Imaging, Cine / methods
  • Magnetic Resonance Spectroscopy / adverse effects
  • Male
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Stroke Volume
  • Ventricular Dysfunction, Right* / diagnostic imaging
  • Ventricular Dysfunction, Right* / etiology
  • Ventricular Dysfunction, Right* / therapy
  • Ventricular Function, Left
  • Ventricular Function, Right