Right Ventricular Function Is a Determinant of Long-Term Survival after Cardiac Resynchronization Therapy

• Published in: Journal of the American Society of Echocardiography Vol. 26; no. 7; pp. 706 - 713
• Main Authors: Sade, Leyla Elif, MD, Özin, Bülent, MD, Atar, Ilyas, MD, Demir, Özlem, MD, Demirtaş, Saadet, MD, Müderrisoğlu, Haldun, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2013
• Subjects: Area Under Curve; Cardiac Resynchronization Therapy; Cardiovascular; Chi-Square Distribution; Echocardiography; Echocardiography - methods; Female; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - therapy; Humans; Male; Middle Aged; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Resynchronization therapy; Right ventricle; ROC Curve; Sensitivity and Specificity; Survival; Survival Rate; Treatment Outcome; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - therapy; Interventricular mechanical delay; CRT; RV; Left ventricular; Two-dimensional; Resynchronization therapy; LV; Cardiac resynchronization therapy; 2D; Cardiac Resynchronization–Heart Failure; Predictors of Response to Cardiac Resynchronization Therapy; EF; Echocardiography; Right ventricle; IVMD; ESV; CMR; CARE-HF; TAPSE; Survival; PROSPECT; Cardiac magnetic resonance; Tricuspid annular plane systolic excursion; Right ventricular; End-systolic volume; Ejection fraction
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2013.03.013

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.