From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada.
Radiology. 2021 Nov;301(2):322-329. doi: 10.1148/radiol.2021210246. Epub 2021 Aug 17.
Background Right ventricular ejection fraction (RVEF) is an independent predictor of death and adverse cardiovascular outcomes in patients with various cardiac conditions. Purpose To investigate whether RVEF, measured with cardiac MRI, is a predictor of appropriate shock or death in implantable cardioverter-defibrillator (ICD) recipients for primary and secondary prevention of sudden cardiac death. Materials and Methods This retrospective, multicenter, observational study included patients who underwent cardiac MRI before ICD implantation between January 2007 and May 2017. Right ventricular end-diastolic and end-systolic volumes and RVEF were measured with cardiac MRI. The primary end point was a composite of all-cause mortality or appropriate ICD shock. The secondary end point was all-cause mortality. The association between RVEF and primary and secondary outcomes was evaluated by using multivariable Cox regression analysis. Potential interactions were tested between primary prevention, ischemic cause, left ventricular ejection fraction (LVEF), and RVEF. Results Among 411 patients (mean age ± standard deviation, 60 years; 315 men) during a median follow-up of 63 months, 143 (35%) patients experienced an appropriate ICD shock or died. In univariable analysis, lower RVEF was associated with greater risks for appropriate ICD shock or death and for death alone (log-rank trend test, = .003 and .005 respectively). In multivariable Cox regression analysis adjusting for age at ICD implantation, LVEF, ICD indication (primary vs secondary), ischemic heart disease, and late gadolinium enhancement, RVEF was an independent predictor of the primary outcome (hazard ratio [HR], 1.21 per 10% lower RVEF; 95% CI: 1.04, 1.41; = .01) and all-cause mortality (HR, 1.25 per 10% lower RVEF; 95% CI: 1.01, 1.55; = .04). No evidence of significant interactions was found between RVEF and primary or secondary prevention ( = .49), ischemic heart disease ( = .78), and LVEF ( = .29). Conclusion Right ventricular ejection fraction measured with cardiac MRI was a predictor of appropriate implantable cardioverter-defibrillator shock or death. © RSNA, 2021 See also the editorial by Nazarian and Zghaib in this issue.
背景 右心室射血分数（RVEF）是各种心脏疾病患者死亡和心血管不良结局的独立预测因素。目的 研究心脏 MRI 测量的 RVEF 是否可预测植入式心脏复律除颤器（ICD）用于一级和二级预防心源性猝死患者的合适电击或死亡。材料与方法 本回顾性多中心观察性研究纳入了 2007 年 1 月至 2017 年 5 月期间在 ICD 植入前接受心脏 MRI 检查的患者。使用心脏 MRI 测量右心室舒张末期和收缩末期容积及 RVEF。主要终点为全因死亡率或合适 ICD 电击的复合终点。次要终点为全因死亡率。使用多变量 Cox 回归分析评估 RVEF 与主要和次要结局之间的关系。在一级预防、缺血性病因、左心室射血分数（LVEF）和 RVEF 之间测试了潜在的相互作用。结果 在中位随访 63 个月期间，411 例患者（平均年龄±标准差，60 岁；315 例男性）中，143 例（35%）患者经历了合适的 ICD 电击或死亡。单变量分析显示，较低的 RVEF 与更大的合适 ICD 电击或死亡风险以及单独死亡风险相关（对数秩趋势检验， =.003 和.005）。在调整 ICD 植入年龄、LVEF、ICD 适应证（一级与二级）、缺血性心脏病和晚期钆增强后进行多变量 Cox 回归分析，RVEF 是主要结局（风险比[HR]，每降低 10% RVEF 增加 1.21；95%CI：1.04，1.41； =.01）和全因死亡率（HR，每降低 10% RVEF 增加 1.25；95%CI：1.01，1.55； =.04）的独立预测因素。未发现 RVEF 与一级或二级预防（ =.49）、缺血性心脏病（ =.78）和 LVEF（ =.29）之间存在显著交互作用的证据。结论 心脏 MRI 测量的 RVEF 是预测合适的植入式心脏复律除颤器电击或死亡的指标。
