title: Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure).
abstract: OBJECTIVE
  The aim of this study was to investigate the impact of cardiac resynchronization therapy (CRT) on right ventricular (RV) function and the influence of RV dysfunction on the echocardiographic and clinical response to CRT among patients enrolled in the CARE-HF (Cardiac Resynchronization-Heart Failure) trial.
  
  
  BACKGROUND
  Cardiac resynchronization therapy prolongs survival in appropriately selected patients with heart failure but the benefit might be diminished in patients with RV dysfunction.
  
  
  METHODS
  Of 813 patients enrolled in the CARE-HF study, 688 had tricuspid plane systolic excursion (TAPSE) measured at baseline, and 345 of these were assigned to CRT. Their median (interquartile range) age was 66 (58 to 71) years, left ventricular (LV) ejection fraction was 24% (21% to 28%), and TAPSE was 19 (16 to 22) mm. Baseline LV function and size and QRS duration were similar among TAPSE tertiles, but those in the worst tertile (TAPSE <17.4 mm) were more likely to have ischemic heart disease.
  
  
  RESULTS
  Overall, CRT improved LV but not RV structure and function with little evidence of an interaction with TAPSE. During a median (interquartile range) follow-up of 748 (582 to 950) days, 213 deaths occurred. Patients with lower TAPSE had a higher mortality, regardless of assigned treatment (p < 0.001). Greater inter-ventricular mechanical delay, New York Heart Association functional class, mitral regurgitation, and N-terminal pro-B-type natriuretic peptide, lower TAPSE, and assignment to the control group were independently associated with higher mortality. Reduction in mortality with CRT was similar in each tertile of TAPSE.
  
  
  CONCLUSIONS
  Right ventricular dysfunction is a powerful determinant of prognosis among candidates for CRT, regardless of treatment assigned, but did not diminish the prognostic benefits of CRT among patients enrolled in the CARE-HF trial. (Care-HF CArdiac Resynchronization in Heart Failure; NCT00170300).
authors.affiliation: Department of Cardiology, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Créteil F-94010, France. thibaud.damy@hmn.aphp.fr
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Sandra
authors.initials: S
authors.lastname: Jacobs
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*