Cardiac magnetic resonance assessment of right ventricular remodeling and cardiopulmonary impairment in advanced heart failure patients evaluated for durable mechanical circulatory support
J Miladinovic, D Kosevic, J Stefanovic Neskovic, B Milovanovic, U Radak, N Andjelkovic, N Jovicic, M Bojic, S BorovicAbstract
Background
Advanced heart failure (HF) is frequently complicated by progressive right ventricular (RV) dysfunction, which represents a major cause of outcomes following durable mechanical circulatory support (MCS) implantation. Accurate identification of RV failure using integrated functional and imaging parameters remains a key challenge in advanced HF management.
Purpose
To evaluate the relationship between cardiopulmonary functional capacity and RV structural remodeling in patients with advanced HF referred for assessment at a tertiary HF center, with potential implications for durable MCS selection.
Methods
We retrospectively analyzed 39 consecutive patients with advanced HF referred to a specialized HF center. Demographic data and body mass index (BMI) were recorded. Functional capacity was assessed using cardiopulmonary exercise testing, including oxygen uptake efficiency slope (OUES). RV performance was evaluated using right ventricular stroke work index (RVSWI) and echocardiographic parameters (tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC]). Left ventricular ejection fraction (LVEF) and biventricular end-diastolic volumes were quantified using cardiac magnetic resonance (CMR). Continuous variables are presented as mean ± standard deviation.
Results
The study population was predominantly male (87%), with a mean age of 45 ± 10 years and a mean BMI of 19.0 ± 5.6 kg/m². Patients had biventricular systolic dysfunction, with reduced LVEF (17.8 ± 4.6%), TAPSE (11.1 ± 3.8 mm), and FAC (19.0 ± 5.6%). Functional capacity was profoundly impaired, reflected by a mean OUES of 1.52 ± 0.56. CMR showed significantly increased RV EDV(213 ± 61 mL) and LV EDV(405 ± 117 mL). A significant inverse correlation was observed between OUES and RV end-diastolic volume (r = −0.37, p = 0.022), with patients in the highest RV volume exhibiting the lowest functional efficiency.
Conclusion
In patients with advanced HF, RV dilatation is closely associated with impaired cardiopulmonary efficiency. The integration of CPET-derived functional indices and CMR-based RV volumetric assessment may enhance risk stratification and support informed selection of candidates for MCS.