Deborah Kwon

Milind Y Desai

Rory Hachamovitch

Scott D Flamm

Thomas Marwick

Zoran B Popovic

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POSTER PRESENTATION Open Access
Impact of right ventricular end systolic volume
and mitral regurgitation on survival in patients
with severe ischemic cardiomyopathy
Deborah Kwon1*, Zoran B Popovic1, Milind Y Desai1, Scott D Flamm1, Thomas Marwick2, Rory Hachamovitch1
From 16th Annual SCMR Scientific Sessions
San Francisco, CA, USA. 31 January - 3 February 2013
Background
Mitral regurgitation (MR) and right ventricular dysfunc-
tion have been shown to be an independent predictors
of mortality in patients with severe ischemic cardiomyo-
pathy (ICM). However, it is unclear how right ventricu-
lar end systolic volume index (RVESVi) modifies risk in
patients with ischemic mitral regurgitation. We sought
to assess impact of RVESVi, MR, and the interaction of
these variables on outcomes in patients with ICM.
Methods
450 patients with > 70% stenosis in ≥1 epicardial coronary
artery (75% men, median age 63 years, median LV ejection
fraction (EF) 22 %, median ESVi 106ml, median scar %
of 29% ) underwent delayed hyperenhancement-MRI
(Siemens 1.5-T scanner, Erlangen, Germany) between
2002-2006. CMR evaluation included long and short axis
assessment of LV and RV function on balanced steady
state free precession images along with assessment of LV
and RV myocardial scar (on phase-sensitive inversion
recovery DHE-CMR sequence ~ 10-20 minutes after injec-
tion of 0.2 mmol/kg of Gadolinium dimenglumine). Scar
was identified as regions of interest > 2 SD above normal
myocardium. Cox proportional hazards survival modeling,
using a primary end-point of all-cause mortality, was used
to risk-adjust comparisons. MR severity was determined
1Cleveland Clinic, Cleveland, OH, USA
Full list of author information is available at the end of the article
Figure 1
Kwon et al. Journal of Cardiovascular Magnetic
Resonance 2013, 15(Suppl 1):P252
http://www.jcmr-online.com/content/15/S1/P252
© 2013 Kwon et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
by echocardiography and assessed by width of the vena
contracta. Cox proportional hazards survival modeling,
using a primary end-point of all-cause mortality, was used
to risk-adjust comparisons.
Results
Over a follow-up of up to 9 years[mean 5.8years], 186
deaths occurred. Survival analysis revealed that after
adjusting for age, gender, subsequent CABG, scar burden,
and presence of ICD, RVESVi (c2 16.64, p = 0.0002), MR
(c2 14.17, p=0.0008), and the interaction RVESVi Χ MR
(c2 8.17, p = 0.0043) were independent predictors of mor-
tality. Increasing RVESVi mitigated the risk associated
with increasing MR. On the other hand, increasing MR
resulted in increasing risk in patients with lower RVEVi
(Figure 1).
Conclusions
RVESVi and MR are both powerful independent predic-
tors of mortality; however, increasing RVESVi impacts
the risk associated with ischemic MR in patients with
severe ICM.
Funding
None.
Author details
1Cleveland Clinic, Cleveland, OH, USA. 2Cardiovascular Imaging, Menzies
Research Institute, Hobart, TAS, Australia.
Published: 30 January 2013
doi:10.1186/1532-429X-15-S1-P252
Cite this article as: Kwon et al.: Impact of right ventricular end systolic
volume and mitral regurgitation on survival in patients with severe
ischemic cardiomyopathy. Journal of Cardiovascular Magnetic Resonance
2013 15(Suppl 1):P252.
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Kwon et al. Journal of Cardiovascular Magnetic
Resonance 2013, 15(Suppl 1):P252
http://www.jcmr-online.com/content/15/S1/P252
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Impact of right ventricular end systolic volume and mitral regurgitation on survival in patients with severe ischemic cardiomyopathy

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Impact of right ventricular end systolic volume and mitral regurgitation on survival in patients with severe ischemic cardiomyopathy

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