title: Ventricular response to stress predicts outcome in adult patients with a systemic right ventricle.
abstract: BACKGROUND
  Previous studies demonstrated that ventricular response to stress cardiovascular magnetic resonance (CMR) is frequently abnormal in patients with a systemic right ventricle (RV). However, the clinical implications of these findings remained unknown. We sought to evaluate whether abnormal response to stress CMR predicts adverse outcome in patients with a systemic RV.
  
  
  METHODS
  Thirty-nine adult patients (54% male; mean age 26, range 18-65 years) with a systemic RV underwent stress CMR to determine the response of RV volumes and ejection fraction (EF). During follow-up, cardiac events, defined as hospitalization for heart failure, cardiac surgery, aborted cardiac arrest, or death, were recorded. The prognostic value of an abnormal response to stress, defined as lack of a decrease in RV end-systolic volume (ESV) or lack of an increase in RV EF, was assessed.
  
  
  RESULTS
  We frequently observed an abnormal response to stress, as RV ESV did not decrease in 17 patients (44%), and RV EF did not increase in 15 patients (38%). After a mean follow-up period of 8.1 years, 8 (21%) patients had reached the composite end point. The inability to decrease RV ESV during stress was predictive for cardiac events with a hazard ratio of 2.3 (95% CI 1.19-88.72, P = .034), as was the inability to increase RV EF with a hazard ratio of 2.3 (95% CI 1.31-81.59, P = .027).
  
  
  CONCLUSIONS
  Stress CMR potentially has important prognostic value in patients with a systemic RV. Patients with a systemic RV who show abnormal cardiac response to stress have a substantially higher risk of adverse outcome.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Michiel M
authors.initials: MM
authors.lastname: Winter
authors.forename: Roderick W C
authors.initials: RW
authors.lastname: Scherptong
authors.forename: Sabina
authors.initials: S
authors.lastname: Kumar
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.forename: Igor I
authors.initials: II
authors.lastname: Tulevski
authors.forename: Laurens F
authors.initials: LF
authors.lastname: Tops
authors.forename: Arno A W
authors.initials: AA
authors.lastname: Roest
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000002:abnormalities* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000151:congenital / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult