Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy

Lea Scuteri, Roberto Rordorf, Nina Ajmone Marsan, Maurizio Landolina, Giulia Magrini, Catherine Klersy, Folco Frattini, Barbara Petracci, Alessandro Vicentini, Carlo Campana, Luigi Tavazzi, Stefano Ghio

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Aims: Right ventricular (RV) dysfunction is a marker of poor prognosis in heart failure (HF) patients. It is still unclear whether RV function might influence response to cardiac resynchronization therapy (CRT). Methods: Forty-four consecutive patients with HF, large QRS, and either intraventricular or interventricular dyssynchrony underwent echocardiographic evaluation before, 1 month after, and 6 months after CRT. Response to CRT was considered in case of significant LV reverse remodeling, defined as the occurrence of LV end-systolic volume (LVESV) reduction ≥15% at 6 months. Results: All echocardiographic indexes of baseline RV function and dimensions were significantly more impaired in nonresponders versus responders to CRT: tricuspid annular plane systolic excursion (TAPSE 15 ± 4 mm vs 20 ± 5 mm, P = 0.001), RV systolic pulmonary artery pressure (RVSP 39 ± 14 mmHg vs 27 ± 8 mmHg, P = 0.02), RV end-diastolic area (RVEDA 23 ± 6 cm2 vs 16 ± 3 cm2 P <0.001), RV end-systolic area (RVESA 16 ± 6 cm2 vs 8 ± 2 cm2, P = 0.001), and RV fractional area change (30 ± 12% vs 48 ± 8%, P <0.001). All the indexes of RV function significantly correlated with the percentage of LVESV reduction after CRT. Severe RV dysfunction was defined as TAPSE ≤14 mm and the population was stratified into two groups based on baseline TAPSE ≤ or > 14 mm. As compared to those with high TAPSE (n = 30), patients with low TAPSE (n = 14) were less likely to show LV reverse remodeling after CRT (76% vs 14%, P <0.001). Conclusions: Our study suggests that RV function significantly affects response to CRT. Poor LV reverse remodeling occurs after CRT in patients with HF having severe RV dysfunction at baseline.

Original languageEnglish
Pages (from-to)1040-1049
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume32
Issue number8
DOIs
Publication statusPublished - Aug 2009

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Right Ventricular Function
Cardiac Resynchronization Therapy
Right Ventricular Dysfunction
Heart Failure
Pulmonary Artery
Pressure

Keywords

  • Cardiac resynchronization therapy (CRT)
  • LV reverse remodeling
  • Right ventricle
  • TAPSE

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy. / Scuteri, Lea; Rordorf, Roberto; Marsan, Nina Ajmone; Landolina, Maurizio; Magrini, Giulia; Klersy, Catherine; Frattini, Folco; Petracci, Barbara; Vicentini, Alessandro; Campana, Carlo; Tavazzi, Luigi; Ghio, Stefano.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 32, No. 8, 08.2009, p. 1040-1049.

Research output: Contribution to journalArticle

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abstract = "Aims: Right ventricular (RV) dysfunction is a marker of poor prognosis in heart failure (HF) patients. It is still unclear whether RV function might influence response to cardiac resynchronization therapy (CRT). Methods: Forty-four consecutive patients with HF, large QRS, and either intraventricular or interventricular dyssynchrony underwent echocardiographic evaluation before, 1 month after, and 6 months after CRT. Response to CRT was considered in case of significant LV reverse remodeling, defined as the occurrence of LV end-systolic volume (LVESV) reduction ≥15{\%} at 6 months. Results: All echocardiographic indexes of baseline RV function and dimensions were significantly more impaired in nonresponders versus responders to CRT: tricuspid annular plane systolic excursion (TAPSE 15 ± 4 mm vs 20 ± 5 mm, P = 0.001), RV systolic pulmonary artery pressure (RVSP 39 ± 14 mmHg vs 27 ± 8 mmHg, P = 0.02), RV end-diastolic area (RVEDA 23 ± 6 cm2 vs 16 ± 3 cm2 P <0.001), RV end-systolic area (RVESA 16 ± 6 cm2 vs 8 ± 2 cm2, P = 0.001), and RV fractional area change (30 ± 12{\%} vs 48 ± 8{\%}, P <0.001). All the indexes of RV function significantly correlated with the percentage of LVESV reduction after CRT. Severe RV dysfunction was defined as TAPSE ≤14 mm and the population was stratified into two groups based on baseline TAPSE ≤ or > 14 mm. As compared to those with high TAPSE (n = 30), patients with low TAPSE (n = 14) were less likely to show LV reverse remodeling after CRT (76{\%} vs 14{\%}, P <0.001). Conclusions: Our study suggests that RV function significantly affects response to CRT. Poor LV reverse remodeling occurs after CRT in patients with HF having severe RV dysfunction at baseline.",
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AU - Scuteri, Lea

AU - Rordorf, Roberto

AU - Marsan, Nina Ajmone

AU - Landolina, Maurizio

AU - Magrini, Giulia

AU - Klersy, Catherine

AU - Frattini, Folco

AU - Petracci, Barbara

AU - Vicentini, Alessandro

AU - Campana, Carlo

AU - Tavazzi, Luigi

AU - Ghio, Stefano

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AB - Aims: Right ventricular (RV) dysfunction is a marker of poor prognosis in heart failure (HF) patients. It is still unclear whether RV function might influence response to cardiac resynchronization therapy (CRT). Methods: Forty-four consecutive patients with HF, large QRS, and either intraventricular or interventricular dyssynchrony underwent echocardiographic evaluation before, 1 month after, and 6 months after CRT. Response to CRT was considered in case of significant LV reverse remodeling, defined as the occurrence of LV end-systolic volume (LVESV) reduction ≥15% at 6 months. Results: All echocardiographic indexes of baseline RV function and dimensions were significantly more impaired in nonresponders versus responders to CRT: tricuspid annular plane systolic excursion (TAPSE 15 ± 4 mm vs 20 ± 5 mm, P = 0.001), RV systolic pulmonary artery pressure (RVSP 39 ± 14 mmHg vs 27 ± 8 mmHg, P = 0.02), RV end-diastolic area (RVEDA 23 ± 6 cm2 vs 16 ± 3 cm2 P <0.001), RV end-systolic area (RVESA 16 ± 6 cm2 vs 8 ± 2 cm2, P = 0.001), and RV fractional area change (30 ± 12% vs 48 ± 8%, P <0.001). All the indexes of RV function significantly correlated with the percentage of LVESV reduction after CRT. Severe RV dysfunction was defined as TAPSE ≤14 mm and the population was stratified into two groups based on baseline TAPSE ≤ or > 14 mm. As compared to those with high TAPSE (n = 30), patients with low TAPSE (n = 14) were less likely to show LV reverse remodeling after CRT (76% vs 14%, P <0.001). Conclusions: Our study suggests that RV function significantly affects response to CRT. Poor LV reverse remodeling occurs after CRT in patients with HF having severe RV dysfunction at baseline.

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