0189 : Right ventricular dysfunction in patients presenting with an idiopathic dilated cardiomyopathy: predictive factors and prognostic value

Purpose Right ventricular (RV) dysfunction is a predictor of impaired prognosis in patients presenting with an idiopathic dilated cardiomyopathy (DCM). We intended to determine which parameters were associated with RV dysfunction and to analyze the prognostic role of RV dysfunction independently of the level of LV dysfunction (LVEF and end-diastolic diameter). Methods 136 consecutive patients (73% men, mean age 59.0±13.2 years) with idiopathic DCM (LVEF 45%) were retrospectively enrolled. 34 patients (25%, group 1) presented with RV dysfunction defined as TAPSE δ15mm (tricuspid annular plane systolic excursion) and 102 (group 2) had normal RV function. Patients were followed for a mean time of 2.7±1.1 years for the occurrence of any major adverse cardiac event (MACE: cardiac death and hospitalization, heart transplantation). Results Mean LVEF was 27.5±8.7%. Mean TAPSE was 18.6±5,4mm with an interquartile range of 15-21,8mm. Multivariate predictors of RV dysfunction were LV outflow tract TVI (OR 0.8 (95% CI 0.7-0.9), p=0.003) and E-wave deceleration time δ145ms (OR 4.1 (95% CI 1.3-12.8), p=0.017). MACE-free survival at 1 and 2 years was 64% and 55% respectively in group 1, compared to 87% and 79% in group 2 (p=0.002). By multivariate analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictive factor of MACE (HR 3.2 (95% CI 1.3-7.6), p=0.009), along with right atrium area >20cm 2 and age. Conclusions RV dysfunction defined by TAPSE 15mm is associated with a systolic (aortic TVI) and a diastolic (E-wave DT) LV function parameters. RV dysfunction in patients presenting an idiopathic DCM is an additional and independent prognostic factor independent of the level of LV dysfunction and dilatation.