title: Right ventricular function is a determinant of long-term survival after cardiac resynchronization therapy.
abstract: BACKGROUND
  Right ventricular (RV) dysfunction is a marker of poor prognosis in patients with heart failure. The aim of this study was to investigate the impact of RV function on the long-term outcomes of patients undergoing cardiac resynchronization therapy (CRT).
  
  
  METHODS
  A total of 120 consecutive patients treated with CRT according to guideline criteria were followed over 5 years. Comprehensive echocardiographic analyses of RV function and radial and longitudinal mechanical left ventricular dyssynchrony were performed at baseline and 6 months after implantation. RV function was evaluated by two-dimensional longitudinal strain of the free wall, fractional area change, tricuspid annular plane systolic excursion, and tricuspid annular systolic velocity. Long-term follow-up events were defined as all-cause mortality, heart transplantation, or assist device implantation.
  
  
  RESULTS
  Long-term events occurred in 38 patients. Among the studied variables for RV function, RV strain < 18% had the highest sensitivity (79%) and specificity (84%) to predict a poor outcome after CRT (area under curve, 0.821; P < .0001). When adjusted for confounding baseline variables of ischemic etiology, mechanical dyssynchrony, left ventricular end-systolic volume, mitral regurgitation, and medical therapy, RV dysfunction remained independently associated with outcomes, indicating a 5.7-fold increased risk for hard events (P < .0001).
  
  
  CONCLUSIONS
  Preserved RV function as assessed by speckle-tracking strain imaging appears to be an independent predictor of long-term event-free survival after CRT.
authors.affiliation: University of Başkent, Faculty of Medicine, Department of Cardiology, Ankara, Turkey. elifsade@baskent-ank.edu.tr
authors.forename: Leyla Elif
authors.initials: LE
authors.lastname: Sade
authors.forename: Bülent
authors.initials: B
authors.lastname: Özin
authors.forename: Ilyas
authors.initials: I
authors.lastname: Atar
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Demir
authors.forename: Saadet
authors.initials: S
authors.lastname: Demirtaş
authors.forename: Haldun
authors.initials: H
authors.lastname: Müderrisoğlu
mesh_terms: D019540:Area Under Curve; D058406:Cardiac Resynchronization Therapy; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*