Prognostic value of right ventricular ejection fraction using three-dimensional echocardiography in patients with ischemic and dilated cardiomyopathy.

Background: There are few studies reporting the prognostic value of three-dimensional echocardiography (3DE)-derived right ventricular ejection fraction (RVEF) in patients with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).

Methods: 120 ICM and 107 DCM patients who underwent 3DE were retrospectively selected and analyzed using 3DE speckle tracking software. The primary endpoint was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.

Results: During a median follow-up of 24.3 and 53.6 months, 45 patients in ICM and 39 patients in DCM, respectively, reached the primary endpoint. Univariate analysis showed that RVEF was statistically significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI) 0.89-0.95; DCM, HR: 0.90, 95% CI 0.86-0.93, respectively]. In multivariable analysis, RVEF (HR: 0.89-0.92, p < 0.001) was also statistically significantly associated with cardiac events in both ICM and DCM, even after adjustment for clinical factors, left ventricular (LV) systolic and diastolic parameters, or RV systolic parameters. Kaplan-Meier curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e' ≥ 14 and < 14, showed significant risk stratification for both ICM (p = 0.0068) and DCM (p < 0.0001). RVEF had incremental prognostic value over age, E/e', and conventional RV systolic parameters, in both ICM and DCM.

Conclusions: This study confirms the independent and incremental prognostic value of RVEF over conventional echocardiographic parameters in patients with ICM and DCM and allows detailed risk stratification of cardiac events by RVEF and E/e'.