Echocardiographic Evidence of Right Ventricular Dysfunction in Patients with Dilated Cardiomyopathy

Abstract

Background: In dilated cardiomyopathy (DCM), clinical attention primarily focuses on left ventricular (LV) functions, often neglecting the right ventricle (RV). This study aimed to describe the demographics of the patients with a focus on echocardiographic parameters and prevalence of RV dysfunction (RVD) in DCM.
Methods: This cross-sectional descriptive study was conducted in the Cardiology Unit, Department of Internal Medicine, Nepal Manipal Teaching Hospital, Pokhara, from September 2024 to August 2025. Patients who had echocardiographic evidence of DCM were evaluated for RVD based on four criteria: tricuspid annular plane systolic excursion (TAPSE), RV peak systolic velocity (RVS’), myocardial performance index (MPI) also known as TEI index, and RV ejection fraction (RVEF). Data were collected in a structured proforma, and statistical analyses were carried out. This study was approved by institutional research committee.
Results: Of 100 patients (53 males, 47 females; mean age 58.59±11.98 years), mean TAPSE was 19.32±4.08 mm, RVS’ 11.92 ±1.96 cm/s, TEI index 0.49 ±0.097, and RVEF 44.7%±8.04. RVD was diagnosed in 44 patients by at least one criterion. Individually, RVD was identified in 29 patients by TAPSE, 29 patients by TEI criteria, 16 patients by RVS’, and 40 by RVEF. TAPSE and TEI index showed identical classification results (p = 1.000, two-sided exact test), with no statistically significant difference in their performance.
Conclusions: RVEF identified the highest proportion of RVD (40%), supporting its role as a comprehensive reference standard for global RV systolic function. TAPSE exhibited higher sensitivity and specificity than TEI for detection of right ventricular dysfunction.
Keywords: Echocardiography; dilated cardiomyopathy; Nepal; right ventricular function; TAPSE; TEI index.