Objectives This study sought to determine the prevalence, correlates, and impact on cardiac mortality of right ventricular (RV) dysfunction in nonischemic cardiomyopathy.

Background Current heart failure guidelines place little emphasis on RV assessment due to limited available data on determinants of RV function, mechanisms leading to its failure, and relation to outcomes.

Methods We prospectively studied 423 patients with cardiac magnetic resonance (CMR). The pre-specified study endpoint was cardiac mortality. In 100 patients, right heart catheterization was performed as clinically indicated.

Results During a median follow-up time of 6.2 years (interquartile range: 2.9 to 7.6 years), 101 patients (24%) died of cardiac causes. CMR right ventricular ejection fraction (RVEF) was a strong independent predictor of cardiac mortality after adjustment for age, heart failure–functional class, blood pressure, heart rate, serum sodium, serum creatinine, myocardial scar, and left ventricular ejection fraction (LVEF). Patients with the lowest quintile of RVEF had a nearly 5-fold higher cardiac mortality risk than did patients with the highest quintile (hazard ratio: 4.68; 95% confidence interval [CI]: 2.43 to 9.02; p < 0.0001). RVEF was positively correlated with LVEF (r = 0.60; p < 0.0001), and inversely correlated with right atrial pressure (r = −0.32; p = 0.001), pulmonary artery pressure (r = −0.34; p = 0.0005), transpulmonary gradient (r = −0.28; p = 0.006) but not with pulmonary wedge pressure (r = −0.15; p = 0.13). In multivariable logistic regression analysis of CMR, clinical, and hemodynamic data the strongest predictors of right ventricular dysfunction were LVEF (odds ratio [OR]: 0.85; 95% CI: 0.78 to 0.92; p < 0.0001), transpulmonary gradient (OR: 1.20; 95% CI: 1.09 to 1.32; p = 0.0003), and systolic blood pressure (OR: 0.97; 95% CI: 0.94 to 0.99; p = 0.02).

Conclusions CMR assessment of RVEF provides important prognostic information independent of established risk factors and LVEF in heart failure patients with nonischemic cardiomyopathy. Right ventricular dysfunction is strongly associated with both indices of intrinsic myocardial contractility and increased afterload from pulmonary vascular dysfunction.

目的本研究旨在确定非缺血性心肌病中右心室（RV）功能障碍的患病率，相关性及其对心脏死亡率的影响。

背景技术由于有关右室功能的决定因素，导致其功能衰竭的机制以及与结局的关系的可用数据有限，当前的心力衰竭指南几乎没有重视右室评估。

方法我们对423例心脏磁共振（CMR）患者进行了前瞻性研究。预先指定的研究终点是心脏死亡率。在100名患者中，按照临床指示进行了右心导管插入术。

结果在6.2年的中位随访时间（四分位数范围：2.9至7.6年）中，有101名患者（占24％）死于心脏原因。校正年龄，心力衰竭–功能类别，血压，心率，血清钠，血清肌酐，心肌瘢痕和左心室射血分数（LVEF）后，CMR右心室射血分数（RVEF）是心脏死亡的有力独立预测指标。RVEF五分位数最低的患者的心脏死亡风险比五分位数最高的患者高近5倍（危险比：4.68； 95％置信区间[CI]：2.43至9.02； p <0.0001）。RVEF与LVEF正相关（r = 0.60; p <0.0001），与右心房压力（r = -0.32; p = 0.001），肺动脉压力（r = -0.34; p = 0.0005），肺经梯度呈负相关（r = −0。28; p = 0.006），但不伴有肺楔形压（r = -0.15; p = 0.13）。在CMR，临床和血液动力学数据的多变量logistic回归分析中，最正确的预测右室功能障碍的指标是LVEF（优势比[OR]：0.85； 95％CI：0.78至0.92； p <0.0001），经肺梯度（OR：1.20） ； 95％CI：1.09至1.32； p = 0.0003）和收缩压（OR：0.97； 95％CI：0.94至0.99； p = 0.02）。

结论对于非缺血性心肌病的心力衰竭患者，RVEF的CMR评估可提供重要的预后信息，而与既定的危险因素和LVEF无关。右心功能不全与固有心肌收缩指数和肺血管功能不全后负荷增加均密切相关。