Abstract 17495: Relationship of Baseline Right Ventricular Function, Left Ventricular Lead Position and Survival Following Cardiac Resynchronization Therapy
Background Right ventricular (RV) function is an important prognostic marker in patients with heart failure and has been shown to predict long-term mortality and left ventricular (LV) reverse remodeling after CRT. Optimum LV lead position has emerged as important predictor of both LV remodeling and survival. This study evaluated the impact of RV function on response to CRT and relate this to the position of the LV lead.
Methods We retrospectively analyzed the echocardiograms of 166 patients who received CRT. RV function was assessed using tricupsid annular plane systolic excursion (TAPSE) and fractional area change (FAC). Optimum LV lead position was guided using the most delayed segment by speckle tracking radial strain. Endpoints were response to CRT (>15% reduction in LVESV) at 6 months and all cause mortality.
Results There was no difference in baseline RV function between CRT responders (n=112) and non-responders (n=54): TAPSE 1.9±0.6 vs.1.7±0.6 cm p=0.09, FAC 42%±15 vs. 38.5%±14 p=0.2. At a median of 30 months after CRT, 29 deaths had occurred. Impaired RV function (TAPSE <1.4) was associated with increased mortality (log-rank p =0.013). There was no association between baseline LV and RV function or between RV function and reduction in LVESV. Patients with an appropriately placed LV lead had improved survival compared to the 30 patients with a remote lead (log-rank p=0.015). Although both RV function and lead position were independent predictors of survival on multivariate analysis, TAPSE <1.4 cm was associated with increased mortality in patients with a concordant or adjacent lead (log rank p=0.04) and had no impact on survival in patients with a remote lead (log rank p=0.35).
Conclusions Pre-procedural RV function is a predictor of outcome following CRT with greatest impact in patients with either an adjacent or concordant LV lead. The effect of RV function on survival appears to be less important in those patients with a remotely positioned LV lead.
- © 2012 by American Heart Association, Inc.