title: Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy.
abstract: OBJECTIVE
  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 > or =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 cm(2) vs 16 +/- 3 cm(2) P < 0.001), RV end-systolic area (RVESA 16 +/- 6 cm(2) vs 8 +/- 2 cm(2), 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 < or =14 mm and the population was stratified into two groups based on baseline TAPSE < or = 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.
authors: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Lea
authors: L
authors: Scuteri
authors: Roberto
authors: R
authors: Rordorf
authors: Nina Ajmone
authors: NA
authors: Marsan
authors: Maurizio
authors: M
authors: Landolina
authors: Giulia
authors: G
authors: Magrini
authors: Catherine
authors: C
authors: Klersy
authors: Folco
authors: F
authors: Frattini
authors: Barbara
authors: B
authors: Petracci
authors: Alessandro
authors: A
authors: Vicentini
authors: Carlo
authors: C
authors: Campana
authors: Luigi
authors: L
authors: Tavazzi
authors: Stefano
authors: S
authors: Ghio
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*