Prognostic Role of Right Ventricular Function in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy

Abstract

BACKGROUND:\ud \ud Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic.\ud HYPOTHESIS:\ud \ud There is a possible association between right ventricular function and response to CRT.\ud METHODS:\ud \ud We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months.\ud RESULTS:\ud \ud The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012).\ud CONCLUSIONS:\ud \ud Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure

Predictors and long‐term outcome of super‐responders to cardiac resynchronization therapy

“…However, previous studies reported more predictors for super‐response to CRT. Female sex, nonischemic cardiomyopathy, wide QRS ≥150 ms, left bundle branch block, body mass index, QRS shortening after CRT, and smaller baseline left atrial volume index were among the predictors for super‐responders . This difference may be due to slightly different study populations.…”

Prognostication of Poor Survival After Cardiac Resynchronization Therapy

“…However, the role of this and other RV function parameters in CRT patient selection is still under dispute. Trials demonstrate different TAPSE cut-off values associated with CRT outcome (15 mm [35], 17 mm [36]) but their diagnostic accuracy is only modest. In single studies there have also appeared other parameters, such as tricuspid lateral annular systolic velocity >9 cm/s and RV global longitudinal strain >12.45%, with very high sensitivity and specificity in predicting LV reverse remodeling [37] or even decreased survival (RV global longitudinal strain <10.04%) [38]), but meta-analysis by Sharma concluded that TAPSE, RV ejection fraction, RV basal strain, and RV fractional area change were not able to predict CRT response as assessed by change in LVEF [39].…”

Prognostic Significance of Left Axis Deviation in Acute Heart Failure Patients with Left Bundle branch block: an Analysis from the Korean Acute Heart Failure (KorAHF) Registry

“…Although numerous studies have been performed to evaluate the impact of RV dysfunction on clinical outcomes and CRT benefit, this issue remains controversial. 26) 27) 28) An additional larger prospective cohort study is needed to evaluate the association between RV dysfunction and CRT benefit or mortality.…”