Assessing Right Ventricular Dysfunction in Ischemic and Nonischemic Cardiomyopathy with Left Ventricular Ejection Fraction (<35%): Insights from Two-dimensional Echocardiography

Export Background: Ischemic cardiomyopathy (ICMP) and Dilated cardiomyopathies (DCMP) impair right ventricular (RV) function through distinct mechanisms, yet comparative data remain limited. This study evaluated and compared RV function in ICMP and DCMP patients with left ventricular ejection fraction (LVEF <35%) using 2D transthoracic echocardiography. Materials and Methods: This prospective study included consecutive patients with ICMP or DCMP and LVEF < 35%. Comprehensive RV assessment included tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), Right Ventricular Myocardial Performance Index (RVMPI), and tissue Doppler S’ velocity. Results: A total of 110 patients were evaluated (59.1% ICMP; 40.9% DCMP). LVEF was comparable between ICMP and DCMP (25.82 ± 5.15% vs. 23.69 ± 6.35%; P = 0.06). RV functional parameters including TAPSE (15.05 ± 3.66 vs. 14.69 ± 3.48 mm; P = 0.61), S′ velocity (9.17 ± 1.65 vs. 8.54 ± 1.89 cm/s; P = 0.06), FAC (34.01 ± 9.10% vs. 33.04 ± 11.34%; P = 0.64), and RVMPI (0.54 ± 0.20 vs. 0.58 ± 0.26; P = 0.40). RV dysplasia (RVD) was observed in 60.0% of ICMP and 73.3% of DCMP patients (P = 0.18), whereas RVSP was higher in DCMP (P = 0.003). LVEF was associated with TAPSE and S′ in DCMP but not ICMP. TAPSE independently predicted RV dysfunction in both groups, where RVMPI (β = –1.1; 95% confidence interval: –2.05 to –0.14; P = 0.03) was predictive only in DCMP. Conclusion: RV dysfunction is commonly accompanies severe left ventricular impairment in both CMP, with higher burden in DCMP. TAPSE and S′ velocity associated with RVD, underscoring their prognostic relevance in advanced cardiomyopathy.