Role of right ventricular wall motion abnormalities in risk stratification and prognosis of patients referred for stress echocardiography

Abstract

Objectives: The purpose of this study was to evaluate the prognostic value of assessing right ventricular (RV) wall motion abnormalities during stress echocardiography (SE).

Background: The results of SE are usually interpreted based on wall motion abnormalities of the left ventricle (LV). There is increasing recognition of the prognostic importance of RV. However, RV is still a "forgotten" chamber during routine SE.

Methods: We evaluated 2,703 patients referred for SE. The LV was evaluated on a 16-segment model 5-point scale and the RV was evaluated on a 3-segment model 5-point scale for wall motion abnormalities. An abnormal RV or LV was defined as one with new (ischemic) or fixed (infarction) wall motion abnormalities. Follow-up (2.7 +/- 1.0 years) for confirmed myocardial infarction and cardiac death (n = 122) were obtained.

Results: An abnormal RV was seen in 112 patients (4%). In the presence of an abnormal LV, patients with abnormal RV had a worse prognosis than those with normal RV. Abnormal RV was a significant predictor of events (adjusted hazard ratio 2.69, 95% confidence interval 1.22 to 5.92; p = 0.014) independent of LV ischemia and ejection fraction. A forward conditional Cox model showed that peak RV wall motion score index provided incremental prognostic value over rest and conventional SE variables (global chi-square increased from 141.4 to 161.8 to 197.0; p < 0.0001 and p = 0.006, respectively).

Conclusions: In patients referred for SE, RV wall motion analysis provides prognostic value independent of LV ischemia and ejection fraction and provides incremental value over rest and conventional SE variables. Right ventricular wall motion analysis should be routinely performed in patients referred for SE for effective risk stratification.