Changes in parameters of right ventricular function with cardiac resynchronization therapy

Abstract

Background Studies have shown that cardiac resynchronization therapy (CRT) significantly improves right ventricle (RV) size and function in patients with heart failure (HF). Hypothesis CRT does not lead to improvement in RV function independent of baseline clinical variables. Methods A systematic search of studies published between 1966 to August 31, 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting tricuspid annular plane systolic excursion (TAPSE) or RV basal strain or RV long axis diameter or RV short axis diameter or RV fractional area change (FAC), before and after CRT, were identified. A meta‐analysis was performed using random effects with inverse variance method to determine the pooled mean difference in various parameters of RV function after CRT. Meta‐regression analysis was performed to test the relationship between change in various parameters of RV functions after CRT and covariates‐ age, QRS duration, and left ventricular ejection fraction (LVEF). Results Thirteen studies (N=1541) were selected for final analysis. CRT therapy led to statistically significant increases in TAPSE [1.21 (95% CI 0.55‐1.86; p<0.001)], RV FAC [2.26 (95% CI 0.50‐4.01; p<0.001)] and basal strain [2.82 (95% CI 0.59‐5.05; p<0.001)] and statistically significant decreases in mean RV long axis diameter [‐2.94 (95% CI ‐5.07‐ ‐0.82; p=0.005)] and short axis diameter [‐1.39 (95% CI ‐2.10‐ ‐0.67; p=0.876)] after a mean follow up period of 9 months. However, after meta‐regression analysis for age, QRS duration, and baseline LVEF as covariates, there was no significant improvement in any of the parameters of RV function after CRT. Conclusion There was a statistically significant improvement in TAPSE, RV basal strain, RV fractional area, RV long axis and short axis with CRT. However, improvement in these echocardiographic parameters of RV function after CRT was not independent of baseline clinical variables but statistically dependent on age, QRS duration and baseline LVEF.

Multimarker approach for assessing efficiency of cardiac resynchronization therapy in patients with sinus rhythm

“…Possible mechanisms of the negative effect of enlarged right parts of the heart are the increase in stagnation, reduction of renal blood flow, with the subsequent development of renal dysfunction. In connection with CRT in patients of group 1 echocardiographic parameters improved not only in the left but also in the right parts of the heart, confirming the literature data on the ability of CRT to cause favorable RV remodeling [15].…”

Is right ventricular resynchronization the key to both right and left ventricular remodeling?

“…There are several studies that demonstrate a positive effect of LV CRT on the RV function, indicating the dependence of both ventricles in biventricular circulation. 6 In short, the presented case emphasizes the need for further studies to evaluate the relevance of RV CRT in patients with RBBB after cardiac surgery and reduced RV function. In particular, prospective, multicentric studies are needed to evaluate long-term outcomes and define the indications and patient selection criteria for a long-term RV CRT.…”

Systemic immune-inflammation index: A novel marker for predicting response to cardiac resynchronization therapy in patients with heart failure

“…In addition, the higher likelihood of having a decrease in SII values during 6-month CRT in our patients with higher baseline QRS seems notable given the role of morphology of QRS waves in deciding ventricular dyssynchrony for CRT inclusion criteria as well as the consideration of a strong positive correlation between the larger QRS area in the pre-treatment period with better CRT response [11]. Besides its well-known effects on LV function (i.e., improved LVEF, decreased intraventricular mechanical dyssynchrony, and favorable LV remodeling) [27,28], some studies have also suggested the association of CRT with significant improvements in RV size and function in patients with HF [29][30][31][32]. In the current study, apart from achievement of CRT response (based on EF, LVESV and NYHA) in at least 60% of patients, SII change during CRT was also correlated with echocardiographic parameters of RV function (negatively with TAPSE and RV FAC, and positively with RVES area and RVED area).…”