Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. Right ventricular function predicts transplant-free survival in idiopathic dilated cardiomyopathy Luigi La Vecchia a , Leonardo Varotto a , Luisa Zanolla b , Gian Luca Spadaro a and Alessandro Fontanelli a Background Right ventricular function may be reduced in patients with idiopathic dilated cardiomyopathy (IDC). The prognostic implications of right ventricular dysfunction have not been investigated in this group of patients. Methods In a series of 120 consecutive patients with IDC [defined as a left ventricular ejection fraction (LVEF) < 55%, normal coronary arteries and no other causes for left ventricular dysfunction], right ventricular function was prospectively evaluated by means of angiocardiography at the time of catheterization. A head-to-head comparison of ventricular volumes, ejection fraction, end-diastolic pressure, stroke work index and end-systolic pressure/ volume ratio of the left and right ventricle was performed according to the Cox’s proportional hazard method for the pre-defined end-point of transplant-free survival. Results In the study population, LVEF was 31 W 11% and right ventricular ejection fraction (RVEF) was 34 W 10%. After a mean follow-up of 30 months (range 12– 120 months), 26 patients died (22%) and 14 (12%) underwent heart transplantation. At univariate analysis, all the above mentioned parameters were significantly (P < 0.0001) associated with outcome except left and right ventricular end-systolic pressure/volume ratio. At multivariate analysis, independent predictors of transplant- free survival were RVEF (P U 0.001), right ventricular stroke work index (P U 0.015), right ventricular end-diastolic volume (P U 0.034) and left ventricular end-diastolic volume (P U 0.048), but not LVEF. The same relation holds true considering the end point of total mortality. Conclusions Parameters of right ventricular function are strong predictors of survival in IDC, even in patients enrolled over a wide range of LVEFs. The present study suggests that right ventricular function should be evaluated in patients with IDC. A large non-invasive based study on right ventricular function in IDC appears to be warranted. J Cardiovasc Med 7:706–710 Q 2006 Italian Federation of Cardiology. Journal of Cardiovascular Medicine 2006, 7:706–710 Keywords: cardiomyopathy, prognosis, ventricular function a Department of Cardiology, S. Bortolo Hospital, Vicenza and b Department of Cardiology, Borgo Trento Hospital, Verona, Italy Correspondence and requests for reprints to Dr Luigi La Vecchia, U.O. di Cardiologia, Viale Rodolfi no. 37, 36100 Vicenza, Italy Tel: +39 444 753767; fax: +39 444 753162; e-mail: luigilavecchia@libero.it Received 6 September 2005 Revised 20 February 2006 Accepted 21 February 2006 Introduction The diagnosis of idiopathic dilated cardiomyopathy (IDC) is based on the presence of dilatation and hypo- kinesia of the left ventricle [1], whose entity may range from mild dysfunction to severe impairment responsible for the clinical syndrome of heart failure. Left ventricular dimensions and systolic function are routinely measured not only to define the presence of IDC, but also to follow the clinical course of the disease, monitor progression to overt heart failure, verify efficacy of treatment, and stratify prognosis [2]. This approach relies upon the availability of relatively simple and repeatable non- invasive methods to evaluate left ventricular volumes and ejection fraction [3]. Although left ventricular dys- function is required for the diagnosis of IDC, left ven- tricular dysfunction alone does not explain the entire syndrome of IDC, in particular the variable presence of symptoms, physical deconditioning and exercise per- formance [4–6]. In addition, left ventricular dysfunction has been found to be a poor predictor of prognosis, especially in patients who present with severely reduced left ventricular ejection fraction (LVEF) [7,8]. Patients with IDC may have a variable degree of right ventricular dysfunction associated with left ventricular impairment [1]. Previous observations suggest that sys- tematic evaluation of the right ventricle allows the clin- ician to detect a high frequency of dysfunction in IDC [9]. Parallel to these studies, the prognostic role of right ventricular function in patients with severe [10], as well as mild-to-moderate heart failure [11], has emerged. Based on these observations, the present study comprised an attempt to perform a head-to-head comparison of parameters of left and right ventricular function in a series of prospectively enrolled patients with IDC, Original article 1558-2027 ß 2006 Italian Federation of Cardiology