Prognostic value of right ventricular dysfunction in patients with left ventricular non-compaction cardiomyopathy

Objective. To estimate prognostic value of RV dysfunction for adverse events and outcomes in patients with left ventricular non-compaction cardiomyopathy. Material and methods. There were 218 patients with left ventricular non-compaction cardiomyopathy (141 men and 77 women, median age 38.8 [30.0; 50.4] years). In addition to conventional examination, all patients underwent cardiac contrast-enhanced magnetic resonance imaging. The primary composite endpoint were the following adverse events and outcomes: hospitalization due to progression of CHF, implantation of ICD/ CRT-D for sustained VT/VF, orthotopic heart transplantation, all-cause mortality. The secondary composite endpoint were life-threatening ventricular arrhythmias requiring ICD/CRT-D implantation and all-cause mortality. Results. RV dysfunction was detected in 66 (31.1%) out of 212 patients. RV EF correlated with LV dysfunction (r=0.597, p<0.001). According to cardiac contrast-enhanced magnetic resonance imaging, myocardial fibrosis was more common in patients with RV dysfunction compared to patients with preserved RV function (38 (57.6%) and 57 (39%), respectively, p=0.012). During the follow-up period (median 60 months [10; 106]), 96 (45.3%) patients reached the composite primary point. RV dysfunction was significantly associated with shorter period until composite primary (HR 3.43; 95% CI 2.24—5.26) and secondary endpoints (HR 3.11; 95% CI 2.02—4.79). Independent predictors of primary composite endpoint were LVEF <45% and myocardial fibrosis. Conclusion. RV dysfunction was more common in patients with severe symptoms of HF and myocardial remodeling, including LV dysfunction and myocardial fibrosis. RV dysfunction was associated with shorter period until composite endpoints (hospitalization due to progression of CHF, orthotopic heart transplantation, arrhythmic events with implantation of ICD/CRT-D and all-cause mortality).