Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy

Subhi J. Al'Aref, Ahmed M. Altibi, Abdallah Malkawi, Munthir Mansour, Lohendran Baskaran, Ahmad Masri, Hind Rahmouni, Raffaele Abete, Daniele Andreini, Giovanni Aquaro, Andrea Barison, Jan Bogaert, Giovanni Camastra, Samuela Carigi, Nazario Carrabba, Grazia Casavecchia, Stefano Censi, Gloria Cicala, Edoardo Conte, Carlo N. De CeccoManuel De Lazzari, Gabriella Di Giovine, Mauro Di Roma, Monica Dobrovie, Marta Focardi, Nicola Gaibazzi, Annalaura Gismondi, Matteo Gravina, Marco Guglielmo, Chiara Lanzillo, Massimo Lombardi, Valentina Lorenzoni, Jordi Lozano-Torres, Davide Margonato, Chiara Martini, Francesca Marzo, Piergiorgio Masci, Ambra Masi, Riccardo Memeo, Claudio Moro, Saima Mushtaq, Alberto Nese, Alessandro Palumbo, Anne Giulia Pavon, Patrizia Pedrotti, Mauro Pepi, Martina Perazzolo Marra, Silvia Pica, Silvia Pradella, Cristina Presicci, Mark G. Rabbat, Claudia Raineri, Jose' F. Rodriguez-Palomares, Stefano Sbarbati, U. Joseph Schoepf, Angelo Squeri, Nicola Sverzellati, Rolf Symons, Emily Tat, Mauro Timpani, Giancarlo Todiere, Adele Valentini, Akos Varga-Szemes, Alessandra Volpe, Laura Fusini, Andrea Igoren Guaricci, Jurg Schwitter, Gianluca Pontone*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Aims: Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF). Methods and results: Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan-Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560-1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09-1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function. Conclusion: RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.

Original languageEnglish
Pages (from-to)472-482
Number of pages11
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number4
Publication statusPublished - 1 Apr 2023


  • cardiac magnetic resonance
  • ejection fraction
  • heart failure
  • heart failure hospitalization
  • right ventricular dysfunction

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