Abstract
Background
Despite identifying several risk factors for sudden cardiac death, our ability to predict arrhythmic events in patients with an implantable cardioverter defibrillator (ICD) remains poor. The purpose of this study was to determine if patients who received appropriate ICD shocks had a higher degree of right ventricular (RV) dysfunction at baseline when compared to patients who did not receive ICD shocks.
Methods
We conducted a 1:2 case–control, retrospective study comparing RV end-diastolic and end-systolic areas (RV ED and RV ES areas, respectively), fractional RV area change, and RV wall thickness in 19 consecutive patients who received appropriate ICD shocks (shock group) with another group of 38 patients who did not receive ICD shocks (no-shock group).
Results
There was no significant difference in the RV end-diastolic areas between the groups. However, patients who experienced ICD shocks had a higher RV end-systolic area and a lower RV fractional area change when compared to patients without ICD shocks, 16.3 ± 4.9 cm2 and 27.7 ± 9.0% in the shock group versus 14.2 ± 4.4 cm2 and 35.8 ± 10.3% in the no-shock group; (p = 0.08 and 0.004, respectively). Furthermore, the RV wall thickness was greater in patients with ICD shocks when compared to patients without ICD shocks, 0.49 ± 0.05 cm and 0.44 ± 0.04 cm, respectively (p = 0.001). Utilizing a logistic regression analysis and after controlling for variables with univariate significance (p < 0.1), RV wall thickness independently predicted ICD shocks (OR 13.9 mm−1 change of RV thickness, p = 0.004).
Conclusion
Our findings suggest that some measurements of RV function might prove to be useful in predicting future arrhythmic events. Additional prospective studies are needed to test this hypothesis.
Similar content being viewed by others
References
Sabit, R., Bolton, C. E., Fraser, A. G., Edwards, J. M., Edwards, P. H., Ionescu, A. A., et al. (2010). Sub-clinical left and right ventricular dysfunction in patients with COPD. Respiratory Medicine, 104(8), 1171–1178.
Tugcu, A., Yildirimturk, O., Tayyareci, Y., Demiroglu, C., & Aytekin, S. (2010). Evaluation of subclinical right ventricular dysfunction in obstructive sleep apnea patients using velocity vector imaging. Circulation Journal, 74(2), 312–319.
Anavekar, N. S., Gerson, D., Skali, H., Kwong, R. Y., Yucel, E. K., & Solomon, S. D. (2007). Two-dimensional assessment of right ventricular function: An echocardiographic-MRI correlative study. Echocardiography, 24(5), 452–456.
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2005). Recommendations for chamber quantification: A report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. Journal of the American Society of Echocardiography, 18(12), 1440–1463.
Anavekar, N. S., Skali, H., Bourgoun, M., Ghali, J. K., Kober, L., Maggioni, A. P., et al. (2008). Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). The American Journal of Cardiology, 101(5), 607–612.
Engstrom, A. E., Vis, M. M., Bouma, B. J., van den Brink, R. B., Baan, J., Jr., Claessen, B. E., et al. (2010). Right ventricular dysfunction is an independent predictor for mortality in ST-elevation myocardial infarction patients presenting with cardiogenic shock on admission. European Journal of Heart Failure, 12(3), 276–282.
Baker, B. J., Wilen, M. M., Boyd, C. M., Dinh, H., & Franciosa, J. A. (1984). Relation of right ventricular ejection fraction to exercise capacity in chronic left ventricular failure. The American Journal of Cardiology, 54(6), 596–599.
Di Salvo, T. G., Mathier, M., Semigran, M. J., & Dec, G. W. (1995). Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. Journal of the American College of Cardiology, 25(5), 1143–1153.
Juilliere, Y., Barbier, G., Feldmann, L., Grentzinger, A., Danchin, N., & Cherrier, F. (1997). Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy. European Heart Journal, 18(2), 276–280.
La Vecchia, L., Zanolla, L., Varotto, L., Bonanno, C., Spadaro, G. L., Ometto, R., et al. (2001). Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction. American Heart Journal, 142(1), 181–189.
Maslow, A. D., Regan, M. M., Panzica, P., Heindel, S., Mashikian, J., & Comunale, M. E. (2002). Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesthesia and Analgesia, 95(6), 1507–1518.
Aktas, M. K., Kim, D. D., McNitt, S., Huang, D. T., Rosero, S. Z., Hall, B. W., et al. (2009). Right ventricular dysfunction and the incidence of implantable cardioverter-defibrillator therapies. Pacing and Clinical Electrophysiology, 32(12), 1501–1508.
Davies, S. W., & Wedzicha, J. A. (1993). Hypoxia and the heart. British Heart Journal, 69(1), 3–5.
Shepard, J. W., Jr., Garrison, M. W., Grither, D. A., & Dolan, G. F. (1985). Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest, 88(3), 335–340.
No conflicts of interest to report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Malasana, G., Daccarett, M., Kuppahally, S. et al. High prevalence of right ventricular dysfunction in ICD patients with shocks: a potential new predictor in risk stratification. J Interv Card Electrophysiol 31, 165–169 (2011). https://doi.org/10.1007/s10840-010-9536-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-010-9536-y