title: Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction.
abstract: Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance.
  
  
  
  Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02).
  
  
  
  RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Umjeet
authors.initials: U
authors.lastname: Jolly
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Bobak
authors.initials: B
authors.lastname: Heydari
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Mingkai
authors.initials: M
authors.lastname: Peng
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Fahad
authors.initials: F
authors.lastname: Almehmadi
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Zahrani
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Bokhari
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: John
authors.initials: J
authors.lastname: Stirrat
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Carmen P
authors.initials: CP
authors.lastname: Lydell
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Howarth
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.).
authors.forename: Raymond
authors.initials: R
authors.lastname: Yee
authors.affiliation: From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.). jawhit@ucalgary.ca.
authors.forename: James A
authors.initials: JA
authors.lastname: White
mesh_terms: D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy
chemical_list: D003287:Contrast Media
keywords: arrhythmias, cardiac; death, sudden, cardiac; magnetic resonance imaging; prognosis; ventricular dysfunction, right