Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure.

Aims The aim of this study was to investigate the prognostic impact of right ventricular (RV) size in patients with chronic heart failure. Methods and results Normal volunteers (n = 80) and patients (n = 380) with left ventricular (LV) ejection fraction 2 SD beyond the mean) (25%) had more frequent evidence of fluid overload in clinical examination and greater LV dimensions (P < 0.0001). During follow-up (median 45, interquartile range: 28–66 months), 37% of patients with and 24% without RV dilation died (log-rank test = 8.4; P = 0.004). In a multivariable Cox regression model, including 13 other clinical variables, RV (HR: 1.08/10 mL/m2, 95% CI: 1.00–1.18, P = 0.044), but not LV, end-systolic volume index predicted a worse outcome. Conclusion Twenty-five per cent of patients with heart failure due to LV systolic dysfunction have a dilated right ventricle. Greater RV dimensions predict mortality in patients with chronic heart failure. Treatments aimed at preserving or enhancing RV structure and function, possibly by unloading the RV by reducing pulmonary vascular resistance or left atrial pressure, should be investigated.