Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy.
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.
Scuteri
Lea
L
Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Rordorf
Roberto
R
Marsan
Nina Ajmone
NA
Landolina
Maurizio
M
Magrini
Giulia
G
Klersy
Catherine
C
Frattini
Folco
F
Petracci
Barbara
B
Vicentini
Alessandro
A
Campana
Carlo
C
Tavazzi
Luigi
L
Ghio
Stefano
S
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*