Right ventricular dysfunction was associated with nearly fourfold greater odds of sudden cardiac death or severe ventricular arrhythmias, suggesting that assessment of right ventricular function may provide additional prognostic information alongside conventional left ventricular evaluation for arrhythmic risk stratification, based on a study published in the journal Clinical Research in Cardiology.

Researchers conducted a systematic review and meta-analysis, searching PubMed, Embase, and Web of Science from database inception through February 2025. Seven studies comprising 1,475 patients met the inclusion criteria, including 541 patients with right ventricular (RV) dysfunction. Mean follow-up was 2.9 years. RV dysfunction was assessed using RV fractional area change, RV ejection fraction (RVEF), or RV strain measured by echocardiography or cardiac magnetic resonance imaging. The primary endpoint was a composite outcome of sudden cardiac death or severe ventricular arrhythmias. A secondary analysis compared the prognostic value of RV function vs left ventricular (LV) ejection fraction (LVEF).

During follow-up, 223 patients experienced the composite outcome. Patients with RV dysfunction had 3.69 times the odds of sudden cardiac death or severe ventricular arrhythmias compared with those without RV dysfunction. The association was found to remain statistically significant in the subgroup of studies enrolling patients with ischemic or nonischemic cardiomyopathy, with those with RV dysfunction having 2.93 times the odds of the composite outcome. Separate analyses also demonstrated statistically significant associations when sudden cardiac death and ventricular arrhythmias were evaluated individually.

The secondary analysis showed that patients who experienced sudden cardiac death or severe ventricular arrhythmias had lower RV fractional area change than those without events. By contrast, no statistically significant difference in LVEF was observed between the groups. The researchers said these findings suggest RV function may provide incremental prognostic information beyond LVEF in selected patient populations rather than replace current risk assessment.

Sensitivity analyses showed that the association between RV dysfunction and arrhythmic outcomes remained robust when individual studies were excluded. Most included studies were rated as high quality, and the researchers found no evidence of substantial publication bias.

The researchers cautioned that definitions of RV dysfunction differed across studies, with varying imaging modalities and cutoff values. Baseline patient characteristics also varied, the small number of studies limited detailed subgroup analyses, and comparisons between RV and LV function were restricted because only a subset of studies reported both measures. These limitations may affect the generalizability of the findings.

Overall, the findings suggest that assessment of RV function may complement conventional risk stratification for sudden cardiac death and severe ventricular arrhythmias, although larger studies using standardized measures are needed before its role in clinical practice can be established. As wrote lead study author Toshinori Chiba, MD, of the Department of Cardiology, Deutsches Herzzentrum der Charité, Campus Mitte, Berlin, Germany, and colleagues, "RV dysfunction may provide incremental prognostic information beyond LVEF in predicting these outcomes."

This study received Open Access funding through Projekt DEAL. The authors reported no conflicts of interest.

Source: Clinical Research in Cardiology