Abstract 16643: Right Ventricular Systolic Dysfunction Assessed by Cardiac Magnetic Resonance is a Strong Predictor of Cardiovascular Death After Coronary Bypass Surgery

BACKGROUND: Although increased left ventricular (LV) volumes and reduced ejection fraction (EF) are associated with adverse outcomes in heart failure (HF), there are limited data regarding the prognostic value of right ventricular (RV) systolic dysfunction (RVSD) in ischemic cardiomyopathy. The purpose of this study was to evaluate the impact of RV function assessment by cardiac magnetic resonance (CMR) before surgical revascularization on survival in patients with coronary artery disease (CAD) and low EF. METHODS: We prospectively evaluated survival of 107 consecutive patients (94 males, age 66 ± 10 years) with CAD and LV dysfunction (EF: 25 ± 7%) undergoing CMR prior complete surgical revascularization. RESULTS: Mean RV function parameters were respectively: RVEDVi 84±28mL/m2, RVESVi 46±25mL/m2 and RVEF 45±16%. RVSD, defined by RV EF ≤35%, was present in 32 (30%) pts. Perioperative mortality at 30 days (n=6 CV death) was significantly higher in patients with RVSD (13% vs. 3%, p=0.043). During the median follow-up of 4.2 years, 42 pts died (worsening HF n=10, sudden death n=12, other CV death n=8, non CV death n=11), 1 pt underwent heart transplantation. The primary end point of cardiovascular death or cardiac transplantation was reached by 14 of 32 pts with RVSD and 17 of 75 pts without RVSD (44% versus 23%, p=0.028). In univariate analysis, age (1.05, 95% CI 1.008-1.09, p= 0.017), eGFR (0.98, 95% CI 0.97-0.99, p=0.017), LVEF (0.94, 95% CI 0.90-0.99, p=0.031) and RVSD (2.51, 95% CI 1.21-5.12, p=0.011) were predictors of the primary end-point. In a stepwise multivariable analysis adjusting for age, eGFR, and LVEF, RVSD remained a significant independent predictor of the primary end-point (HR 3.57; 95% CI, 1.69-7.52; p =0.001). CONCLUSIONS: RVSD is a strong independent predictor of cardiovascular mortality in patients with ischemic cardiomyopathy undergoing coronary bypass surgery. Evaluation of RV function should thus be performed in all HF patients prior surgery.