Right Ventricular Structure Is Associated With the Risk of Heart Failure and Cardiovascular Death: The Multi-Ethnic Study of Atherosclerosis (MESA)-Right Ventricle Study

Study Questions:

Are abnormalities in right ventricular (RV) function and structure associated with mortality?

Methods:

This was a secondary analysis from the MESA study, which was a cohort study enrolling patients without pre-existing coronary disease or heart failure in six US communities between 2000-2002. Patients underwent a cardiac magnetic resonance imaging (cMRI) with measurement of RV volumes, mass, and ejection fraction (EF). Patients were contacted at 9 and 12 months to assess mortality, interim hospitalization, and new cardiovascular outpatient diagnoses.

Results:

Of 6,814 patients enrolled into MESA, 4,202 had cMRIs that were sufficient for RV analysis. Mean patient age was 61.4 ± 10.1 years, 48% were men, and 11.5% were diabetic. Over 5.8 years of follow-up, there were 78 (2%) HF events and 34 (0.8%) deaths. Coronary disease and stroke accounted for 62% (n = 21) and 12% (n = 4) of the deaths. The 5-year risks of HF and death were 1.6% and 0.7%, respectively. The presence of RV hypertrophy was associated with an adjusted (hazard ratio, 1.9; 95% confidence interval, 1.1-3.5) risk of HF or death. RVEF and RV volumes were not significantly associated with mortality or an incident HF diagnosis on multivariable analysis.

Conclusions:

The authors concluded that patients who have RV hypertrophy have a higher risk of death and HF development.

Perspective:

The right ventricle is often ignored in clinical cardiology. Yet, this chamber is responsible for filling the left ventricle, and can impact other vital organs (e.g., liver, kidneys). Herein, the authors used cMRI to assess RV mass and function. One would expect that diastolic LV abnormalities or pulmonary hypertension would lead to RV hypertrophy, which would then proceed to RV enlargement and a subsequent reduction in RVEF. The presence of RV enlargement was associated with an increased risk of adverse outcome alone, but this risk was attenuated after controlling for LV volumes and other traditional cardiovascular risk factors. Further, RVEF was not associated with increased mortality or clinical HF in multivariable modeling. We have much to understand about the right ventricle.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Pulmonary Hypertension and Venous Thromboembolism, Acute Heart Failure, Pulmonary Hypertension, Magnetic Resonance Imaging

Keywords: Ventricular Function, Right, Stroke, Follow-Up Studies, Atherosclerosis, Coronary Disease, Hypertrophy, Right Ventricular, Risk Factors, Magnetic Resonance Imaging, Ventricular Dysfunction, Right, Liver, Heart Failure, Hypertension, Pulmonary, Confidence Intervals, Kidney, Diastole, Hypertrophy, Diabetes Mellitus


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