The first two authors equally contributed to the present work.
Relevance of Echocardiographic Evaluation of Right Ventricular Function in Patients Undergoing Cardiac Resynchronization Therapy
Version of Record online: 17 JUL 2009
©2009, The Authors. Journal compilation ©2009 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 32, Issue 8, pages 1040–1049, August 2009
How to Cite
SCUTERI, L., RORDORF, R., MARSAN, N. A., LANDOLINA, M., MAGRINI, G., KLERSY, C., FRATTINI, F., PETRACCI, B., VICENTINI, A., CAMPANA, C., TAVAZZI, L. and GHIO, S. (2009), Relevance of Echocardiographic Evaluation of Right Ventricular Function in Patients Undergoing Cardiac Resynchronization Therapy. Pacing and Clinical Electrophysiology, 32: 1040–1049. doi: 10.1111/j.1540-8159.2009.02436.x
- Issue online: 17 JUL 2009
- Version of Record online: 17 JUL 2009
- Received November 1, 2008; revised February 8, 2009; accepted March 18, 2009.
- cardiac resynchronization therapy (CRT);
- LV reverse remodeling;
- right ventricle;
Aims: Right ventricular (RV) dysfunction is a marker of poor prognosis in heart failure (HF) patients. It is still unclear whether RV function might influence response to cardiac resynchronization therapy (CRT).
Methods: Forty-four consecutive patients with HF, large QRS, and either intraventricular or interventricular dyssynchrony underwent echocardiographic evaluation before, 1 month after, and 6 months after CRT. Response to CRT was considered in case of significant LV reverse remodeling, defined as the occurrence of LV end-systolic volume (LVESV) reduction ≥15% at 6 months.
Results: All echocardiographic indexes of baseline RV function and dimensions were significantly more impaired in nonresponders versus responders to CRT: tricuspid annular plane systolic excursion (TAPSE 15 ± 4 mm vs 20 ± 5 mm, P = 0.001), RV systolic pulmonary artery pressure (RVSP 39 ± 14 mmHg vs 27 ± 8 mmHg, P = 0.02), RV end-diastolic area (RVEDA 23 ± 6 cm2 vs 16 ± 3 cm2 P < 0.001), RV end-systolic area (RVESA 16 ± 6 cm2 vs 8 ± 2 cm2, P = 0.001), and RV fractional area change (30 ± 12% vs 48 ± 8%, P < 0.001). All the indexes of RV function significantly correlated with the percentage of LVESV reduction after CRT. Severe RV dysfunction was defined as TAPSE ≤14 mm and the population was stratified into two groups based on baseline TAPSE ≤ or > 14 mm. As compared to those with high TAPSE (n = 30), patients with low TAPSE (n = 14) were less likely to show LV reverse remodeling after CRT (76% vs 14%, P < 0.001).
Conclusions: Our study suggests that RV function significantly affects response to CRT. Poor LV reverse remodeling occurs after CRT in patients with HF having severe RV dysfunction at baseline.