title: The Prognostic Impact of the Evolution of RV Function in Idiopathic DCM.
abstract: In this study, the authors analyzed the prognostic role of right ventricular systolic function (RVF) longitudinal trends in a large cohort of patients affected by dilated cardiomyopathy (DCM).
  
  
  
  RVF is a known prognostic predictor in DCM; however, whether RVF changes over time to better predict the long-term disease progression has not been investigated.
  
  
  
  From 1993 to 2008, we analyzed 512 patients with DCM (46 years of age [36 to 55 years of age], left ventricular ejection fraction 32% [25% to 41%]) with a potential follow-up of ≥72 months and available data at baseline and at least 1 pre-specified follow-up evaluation (i.e., 6, 24, 48, or 72 months). RV dysfunction was defined as RV fractional area change <35% at 2-dimensional echocardiography. The primary outcome measure was a composite of death or heart transplantation.
  
  
  
  At enrollment, 103 (20%) patients had RV dysfunction. During follow-up, 89 of them (86%, 17% of the overall cohort) normalized RVF at a median time of 6 months, whereas 38 of the remaining 409 patients with normal baseline RVF (9%; 7% of the overall population) exhibited a new-onset RV dysfunction (median time: 36 months). RVF normalization was significantly associated with subsequent left ventricular reverse remodeling that was observed at a median time of 24 months (odds ratio: 2.49; 95% confidence interval [CI]: 1.17 to 5.3; p = 0.018). At baseline multivariate analysis, RV dysfunction was independently associated with the primary outcome measure (hazard ratio: 1.71; 95% CI: 1.02 to 2.85; p = 0.0413). At time-dependent model, RVF revaluation over time maintained an independent predictive value (hazard ratio: 2.83; 95% CI: 1.57 to 5.11; p = 0.0006).
  
  
  
  Patients with DCM frequently present RV dysfunction at first evaluation. However, a complete RVF recovery is largely observed early after optimization of medical therapy and predates subsequent left ventricular reverse remodeling. Systematic revaluation of patients including RVF throughout regular follow-up conferred additive long-term prognostic value to the baseline evaluation.
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: marco.merlo79@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gobbo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Losurdo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ramani
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy; Cardiovascular Center, Azienda per i Servizi Sanitari n° 1, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pivetta
authors.affiliation: Cardiovascular Center, Azienda per i Servizi Sanitari n° 1, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anzini
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Gigli
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016009:Chi-Square Distribution; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: dilated cardiomyopathy; echocardiography; prognosis; right ventricular function