title: Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomes.
abstract: OBJECTIVE
  Right ventricular (RV) dysfunction has been associated with a worse outcome in heart failure patients undergoing CRT. However, evidence on the RV response to CRT is controversial and there are no data regarding the early effects of CRT on RV function (RVF). We sought to investigate whether a CRT device favourably influences the RVF acutely after implantation, impacting on long-term outcomes.
  
  
  RESULTS
  Patients who successfully underwent CRT device implantation from January 2005 to January 2014 were retrospectively analysed. RV dysfunction was defined by an RV fractional area change <35%. Post-procedural echocardiographic evaluation was performed at a median time of 2 days (interquartile range 1-6 days). The primary endpoint was a composite of all-cause mortality and urgent heart transplantation. A total of 194 patients with available pre- and post-procedural RVF assessment were included. Sixty-two (32%) presented an impaired RVF before the procedure. Of them, 32% showed prompt normalization of RVF following CRT. This occurred in parallel with a large improvement in pulmonary arterial pressure, mitral regurgitation, E/E' ratio, and diastolic function. Pre-implantation independent predictors of early RVF normalization were LBBB (P = 0.034) and higher systolic blood pressure (P = 0.026). Improvement in RVF was independently associated with a better long-term prognosis at multivariable analysis [hazard ratio 0.124; 95% confidence interval 0.016-0.966, P = 0.04).
  
  
  CONCLUSIONS
  Acute normalization of RVF can be observed after CRT along with haemodynamic improvement, and therefore can be used as an independent predictor of transplant-free survival.
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tonet
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Gigli
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ramani
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.affiliation: Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000628:therapy*; D016278:Ventricular Function, Right
keywords: Cardiac resynchronization therapy; Echocardiography; Heart failure; Prognosis; Right ventricle