Document Detail

Ventricular response to stress predicts outcome in adult patients with a systemic right ventricle.
MedLine Citation:
PMID:  21095274     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Previous studies demonstrated that ventricular response to stress cardiovascular magnetic resonance (CMR) is frequently abnormal in patients with a systemic right ventricle (RV). However, the clinical implications of these findings remained unknown. We sought to evaluate whether abnormal response to stress CMR predicts adverse outcome in patients with a systemic RV.
METHODS: Thirty-nine adult patients (54% male; mean age 26, range 18-65 years) with a systemic RV underwent stress CMR to determine the response of RV volumes and ejection fraction (EF). During follow-up, cardiac events, defined as hospitalization for heart failure, cardiac surgery, aborted cardiac arrest, or death, were recorded. The prognostic value of an abnormal response to stress, defined as lack of a decrease in RV end-systolic volume (ESV) or lack of an increase in RV EF, was assessed.
RESULTS: We frequently observed an abnormal response to stress, as RV ESV did not decrease in 17 patients (44%), and RV EF did not increase in 15 patients (38%). After a mean follow-up period of 8.1 years, 8 (21%) patients had reached the composite end point. The inability to decrease RV ESV during stress was predictive for cardiac events with a hazard ratio of 2.3 (95% CI 1.19-88.72, P = .034), as was the inability to increase RV EF with a hazard ratio of 2.3 (95% CI 1.31-81.59, P = .027).
CONCLUSIONS: Stress CMR potentially has important prognostic value in patients with a systemic RV. Patients with a systemic RV who show abnormal cardiac response to stress have a substantially higher risk of adverse outcome.
Michiel M Winter; Roderick W C Scherptong; Sabina Kumar; Berto J Bouma; Igor I Tulevski; Laurens F Tops; Arno A W Roest; Hubert W Vliegen; Albert de Roos; Maarten Groenink; Barbara J M Mulder
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  870-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Exercise Test / methods*
Follow-Up Studies
Heart Ventricles / abnormalities*,  physiopathology
Magnetic Resonance Imaging, Cine
Middle Aged
Retrospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume / physiology*
Ventricular Dysfunction, Right / congenital,  physiopathology*
Ventricular Function, Right / physiology*
Young Adult

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