Dziewięcka Ewa, Banyś Robert, Wiśniowska-Śmiałek Sylwia, Winiarczyk Mateusz, Urbańczyk-Zawadzka Małgorzata, Krupiński Maciej, Mielnik Małgorzata, Lisiecka Monika, Gąsiorek Jarosław, Kyslyi Vladyslav, Płazak Maja, Graczyk Katarzyna, Stępień Agnieszka, Przytuła Natalia, Olszowska Maria, Rubiś Paweł
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Kraków, Poland.
Clinical Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland.
Kardiol Pol. 2025;83(1):62-69. doi: 10.33963/v.phj.102930. Epub 2024 Oct 8.
Although in many patients with dilated cardiomyopathy (DCM), right ventricular systolic dysfunction (RVSD) accompanies left ventricular SD, knowledge about the RVSD prevalence, course, and prognostic significance in DCM remains limited.
We aimed to analyze the prevalence and prognostic significance of longitudinal changes in RV ejection fraction (RVEF) in DCM.
One hundred and two stable DCM patients were included. Heart failure therapy was up-titrated every 3 months, and CMR was performed at baseline and then after 13 (12.2-13.5) months (CMR-1 and CMR-2). RVSD was defined as RVEF <51% in women and <52% in men in CMR-1, while RVEF and LVEF improved if the increase between CMR-1 and CMR-2 was ≥10%. A composite endpoint, including all-cause mortality, heart transplant, left ventricular assistant device, and urgent cardiac hospitalization, was analyzed after 32.6 (26.3-39.4) months.
At baseline, RVSD was observed in 76 (75%) patients. Of 66 DCM patients with RVSD who completed CMR-2, 60% experienced an RVEF improvement. All patients without RVSD at baseline maintained normal RV systolic function at 13 months. Baseline RVSD did not affect the composite endpoint (hazard ratio, 1.241; 95% CI, 0.458-3.366; P = 0.67); however, RVEF improvement was independently associated with this outcome (hazard ratio, 0.260; 95% CI, 0.080-0.846; P = 0.03).
Three-quarters of DCM patients exhibited RVSD at baseline, and 60% of them experienced an RVEF improvement following proper heart failure therapy up-titration. While no relationship between outcome and RVSD was observed, RVEF improvement was associated with a 75% reduction in the composite outcome.
尽管在许多扩张型心肌病（DCM）患者中，右心室收缩功能障碍（RVSD）与左心室收缩功能障碍同时存在，但关于DCM中RVSD的患病率、病程及预后意义的知识仍然有限。
我们旨在分析DCM患者右心室射血分数（RVEF）纵向变化的患病率及预后意义。
纳入102例稳定的DCM患者。每3个月增加心力衰竭治疗剂量，并在基线时以及13（12.2 - 13.5）个月后（CMR - 1和CMR - 2）进行心脏磁共振成像（CMR）检查。RVSD在CMR - 1中定义为女性RVEF <51%，男性RVEF <52%，而如果CMR - 1和CMR - 2之间的增加≥10%，则RVEF和左心室射血分数（LVEF）改善。在32.6（26.3 - 39.4）个月后分析包括全因死亡率、心脏移植、左心室辅助装置及紧急心脏住院的复合终点。
基线时，76（75%）例患者观察到RVSD。在完成CMR - 2的66例有RVSD的DCM患者中，60%经历了RVEF改善。所有基线时无RVSD的患者在13个月时维持正常右心室收缩功能。基线RVSD不影响复合终点（风险比，1.241；95%置信区间，0.458 - 3.366；P = 0.67）；然而，RVEF改善与该结局独立相关（风险比，0.260；95%置信区间，0.080 - 0.846；P = 0.03）。
四分之三的DCM患者在基线时表现出RVSD，其中60%在适当增加心力衰竭治疗剂量后经历了RVEF改善。虽然未观察到结局与RVSD之间的关系，但RVEF改善与复合结局降低75%相关。
