Tricuspid annular plane systolic excursion evaluation improves selection of cardiac resynchronization therapy patients.
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.
Cappelli
Francesco
F
Heart and Vessels Department, University of Florence, Florence, Italy. cappellifrancesco@inwind.it
Cristina Porciani
Maria
M
Ricceri
Ilaria
I
Perrotta
Laura
L
Ricciardi
Giuseppe
G
Pieragnoli
Paolo
P
Paladini
Giulia
G
Michelucci
Antonio
A
Padeletti
Luigi
L
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