Abstract 14734: The Importance of Right Ventricular Function in Survival Following Cardiac Resynchronisation Therapy
Background Right ventricular (RV) function is a key prognostic marker in heart failure with reduced LV systolic function. Its influence on survival following cardiac resynchronisation therapy (CRT) is unknown, however. Furthermore, evidence on the effect of CRT on RV function is limited. The aims of this evaluation were therefore to: 1)characterise RV function at baseline and following CRT, and 2)determine the prognostic importance of RV function amongst CRT recipients.
Methods Consecutive CRT recipients (n=905) underwent transthoracic echocardiography prior to and 6 months after device implantation. RV function was evaluated by tricuspid annular plane systolic excursion (TAPSE). Left ventricular (LV) dyssynchrony was assessed by septal-lateral delay using colour tissue Doppler imaging. The primary endpoint was death or cardiac transplantation.
Results RV and LV function, and LV remodelling improved significantly by 6 months (TAPSE 17±5mm v. 19±6mm, p<0.001; LV ejection fraction 26±8% v. 32±10%, p<0.001; LV end-systolic volume 165±70mL v. 136±64mL, p<0.001). There was no association between the degree of increase in RV function and either the extent of improvement in LV ejection fraction or the degree of decrease in LV end-systolic volume by mixed effects modelling. At a median follow-up of 44 months, 288 endpoint events occurred. RV impairment (TAPSE ≤14mm) was associated with significantly greater incidence of the primary endpoint than preserved RV function (log-rank p<0.001). On multivariate Cox regression, RV function was an independent predictor of the primary endpoint, as were gender, diabetes mellitus, New York Heart Association class, eGFR, MR grade, and LV dyssynchrony.
Conclusion RV function is a potent predictor of long-term outcome following CRT. Figure: Unadjusted relative risk with 95% confidence bands of all-cause mortality following CRT as a function of baseline RV function
- © 2011 by American Heart Association, Inc.