RIGHT-VENTRICULAR DYSFUNCTION - AN INDEPENDENT PREDICTOR OF ADVERSE OUTCOME IN PATIENTS WITH MYOCARDITIS

To assess the predictive value of right ventricular systolic function in patients with active myocarditis, the echocardiograms of 23 patient s with biopsy-confirmed myocarditis were reviewed. Right ventricular s ystolic function was evaluated qualitatively and quantitatively by des cent of the right ventricular base. Patients were divided into those w ith normal right ventricular function, in whom right ventricular desce nt was 1.9 +/- 0.1 cm, and those with abnormal right ventricular funct ion, in whom right ventricular descent was 0.8 +/- 0.1 cm (p < 0.001). There were no differences between the two groups in age, duration of symptoms, baseline hemodynamics, or histologic assessment. Initial lef t ventricular ejection fraction was significantly lower in patients wi th depressed right ventricular function (27.5 +/- 4.9%) compared with that in patients with normal right ventricular function (47.5 +/- 6.3% ) (p = 0.01). The likelihood of an adverse outcome, defined as death o r need for cardiac transplantation, was greater in patients with abnor mal right ventricular function (right ventricular descent less than or equal to 1.7 cm) than in patients with normal right ventricular funct ion (right ventricular descent > 1.7 cm) (p < 0.03). Multivariate anal ysis revealed that right ventricular dysfunction as quantified by righ t ventricular descent was the most powerful predictor of adverse outco me.