title: Prognostic Role of Right Ventricular Function in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy.
abstract: BACKGROUND
  Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic.
  
  
  OBJECTIVE
  There is a possible association between right ventricular function and response to CRT.
  
  
  METHODS
  We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months.
  
  
  RESULTS
  The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012).
  
  
  CONCLUSIONS
  Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure.
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.affiliation: Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maffè
authors.affiliation: Cardiology Unit, Card. G. Panico Hospital, Tricase, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Palmisano
authors.affiliation: Division of Cardiology, Rivoli Hospital, Rivoli, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ferraro
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cecchetto
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Casa di Cura Montevergine, Electrophysiology Department, Mercogliano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Solimene
authors.affiliation: Fondazione Poliambulanza, Cardiology Department, Brescia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Musatti
authors.affiliation: Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Paffoni
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Parravicini
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Agresta
authors.affiliation: Hospital Sant'Anna, Electrophysiology and Cardiac Stimulation Department San Fermo della Battaglia, Italy.
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.affiliation: Cardiac Rhythm Management, Boston Scientific Italia, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Malacrida
authors.affiliation: Clinica Mediterranea, Laboratory of Electrophysiology, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: cardiac resynchronization therapy; heart failure; remodeling heart failure; right ventricular function