title: Tricuspid annular plane systolic excursion evaluation improves selection of cardiac resynchronization therapy patients.
abstract: BACKGROUND
  The beneficial effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) remodeling have been extensively described. Few data are available about the effects of CRT on right ventricular (RV) function and remodeling.
  
  
  OBJECTIVE
  We hypothesized that CRT could also induce reverse remodeling in the right ventricle and that RV baseline functional status expressed as tricuspidal annular plane systolic excursion (TAPSE) could affect CRT response.
  
  
  METHODS
  Echocardiographic investigation was performed before and 6 months after CRT. In 192 patients, TAPSE, LV, and RV dimensions with functional parameters and LV dyssynchrony index were evaluated.
  
  
  RESULTS
  At 6 months' follow-up, 86 patients (45%) were responders to CRT according to at least 15% LV end-systolic volume reduction. Among baseline echocardiographic parameters, responders had significantly lower TAPSE, larger LV volumes, and higher LV dyssynchrony index. In responders, LV volume reduction, ejection fraction increase, and mitral regurgitation improvement were associated with RV dimensions reduction, increased TAPSE, and improved LV dyssynchrony. Receiver operating characteristic curve analysis showed that TAPSE, at 17 mm optimal cutoff, yielded 64% sensitivity and 60% specificity in predicting CRT response; similarly, LV dyssynchrony index, at 41.25 ms optimal cutoff, predicted CRT response with 60% sensitivity and 62% specificity. A subgroup analysis demonstrated that the coexistence of high TAPSE and high dyssynchrony index values increased probability of CRT response.
  
  
  CONCLUSIONS
  Our results show that CRT induces RV and LV reverse remodeling and that CRT patient selection can be improved by simply measuring TAPSE value.
authors.affiliation: Heart and Vessels Department, University of Florence, Florence, Italy. cappellifrancesco@inwind.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Cappelli
authors.forename: Maria
authors.initials: M
authors.lastname: Cristina Porciani
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ricceri
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ricciardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pieragnoli
authors.forename: Giulia
authors.initials: G
authors.lastname: Paladini
authors.forename: Antonio
authors.initials: A
authors.lastname: Michelucci
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D004452:Echocardiography; D005260:Female; D006305:Health Status Indicators; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016014:Linear Models; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling