Characterisation of Echocardiographic Markers of Right Ventricular Function in Non-Ischaemic Cardiomyopathy

Abstract

Non-ischaemic cardiomyopathy (NICM) is characterised by intrinsic myocardial dysfunction that culminates in heart failure (HF), a syndrome associated with significant symptoms, morbidity and mortality. Contemporary guidelines classify and manage NICM solely based on left ventricular (LV) systolic function, often overlooking the significance of the right ventricle (RV). RV function remains under-represented in risk stratification tools and treatment pathways despite its critical role in maintaining cardiac output.

This body of work focuses on echocardiographic measures of RV systolic function given their accessibility and widespread use in clinical practice, including conventional parameters as well as advanced techniques such as speckle-tracking echocardiography and three-dimensional imaging.

We hypothesise that abnormalities of the RV are present even in early NICM and in associated cardiovascular diseases, and that these abnormalities correlate with reduced exercise capacity and adverse cardiovascular outcomes in stable NICM patients.

Our findings confirmed that: each progressive grade of LV systolic dysfunction in NICM is associated with a higher prevalence and increasing severity of RV systolic impairment; elevated body mass index and atrial fibrillation are both associated with reduced RV systolic function even in the absence of other cardiac pathologies; impairment in RV longitudinal function as assessed by RV free wall strain was independently associated with reduced exercise capacity on 6-minute walk test; and a 3D-RVEF reduction to below 44.7% best discriminated for and independently predicted cardiovascular death and HF hospitalisation in compensated NICM patients on optimal contemporary HF therapy.

Our findings emphasises the significant impact of RV function has on HF symptomology and cardiovascular prognosis in patients with NICM.