title: Right ventricular ejection fraction and left ventricular dyssynchrony by 3D echo correlate with functional impairment in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  The aim of the study was to detect if right ventricular (RV) ejection fraction assessed by real-time 3-dimensional echocardiography (RT3DE) could predict patients with dilated cardiomyopathy (DCM) with greater functional impairment in response to cardiopulmonary exercise.
  
  
  RESULTS
  Seventy chronic heart failure patients with DCM (55.5 ± 9.1 years; 48 males; 30 ischemic; New York Heart Association Class III: 48) underwent both left ventricular (LV) and RV analysis by RT3DE. Postprocessing software provided data of RT3DE systolic dyssynchrony index of 16 LV segments (systolic dyssynchrony index [SDI]) and of both LV and RV ejection fraction. Cardiac magnetic resonance was performed in a subgroup of 40 DCM patients to confirm RT3DE measurements. All the patients underwent also bicycle cardiopulmonary exercise test with evaluation of oxygen consumption (VO2) peak% (percentage of the predicted value), VE/VCO2 slope, and circulatory power (CP). Mean LV ejection fraction was 29.8 ± 4.6%. RT3DE LV SDI index was 8.4.4 ± 4.2, and RV ejection fraction was 51.3 ± 4.6%. By cardiopulmonary test, mean VO2 peak was 15.2 ± 4.4 mL·kg·min, and mean CP was 2.1 ± 0.8. By univariable analyses, significant correlations were detectable between SDI index and VO2 peak% (r = -0.56; P < .0001) and peak CP (r = -0.48; P < .0005). Also RV ejection fraction directly correlated with VO2 peak% (r = 0.58; P < .0001) and inversely with VE/VCO2 slope (r = -0.44; P < .001). By multivariable analysis, SDI index (β coefficient = -0.46; P < .001) and 3D RV ejection fraction (β coefficient = 0.42; P < .001) emerged as the only independent determinants of VO2 peak% during cardiopulmonary test.
  
  
  CONCLUSIONS
  Increased LV electromechanical dyssynchrony and impaired RV function in DCM patients are independently associated with worse ability to perform aerobic exercise.
authors: Department of Cardiology, Second University of Naples, Via G. Martucci 35, Naples, Italy. antonellodandrea@libero.it
authors: Antonello
authors: A
authors: D'Andrea
authors: Rita
authors: R
authors: Gravino
authors: Lucia
authors: L
authors: Riegler
authors: Gemma
authors: G
authors: Salerno
authors: Raffaella
authors: R
authors: Scarafile
authors: Massimo
authors: M
authors: Romano
authors: Sergio
authors: S
authors: Cuomo
authors: Luca
authors: L
authors: Del Viscovo
authors: Ilaria
authors: I
authors: Ferrara
authors: Maria Luisa
authors: ML
authors: De Rimini
authors: Pietro
authors: P
authors: Muto
authors: Giuseppe
authors: G
authors: Limongelli
authors: Giuseppe
authors: G
authors: Pacileo
authors: Eduardo
authors: E
authors: Bossone
authors: Maria Giovanna
authors: MG
authors: Russo
authors: Raffaele
authors: R
authors: Calabrò
mesh_terms: D002306:Cardiac Volume; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019560:Echocardiography, Three-Dimensional; D005080:Exercise Test / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010101:Oxygen Consumption; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D016278:Ventricular Function, Right / Q000502:physiology*