Abstract 12113: Early Right Ventricular Response to Cardiac Resynchronization Therapy: Impact on Clinical Outcomes
Introduction: Right ventricular (RV) dysfunction has been associated with a worse outcome in heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT). However, evidences on the RV response to CRT are controversial and there are no data regarding the early effects of CRT on RV function (RVF).
Hypothesis: We sought to investigate whether CRT favorably influences the RVF acutely after implantation, impacting on long-term outcomes.
Methods: Patients who successfully underwent CRT implantation from January 2005 to January 2014 were retrospectively analyzed. RV dysfunction was defined by a RV-fractional area change<35%. Post-procedural echocardiographic evaluation was performed at a median time of 2 days (IQR 1-6). Primary end-point was a composite of all-cause mortality and urgent heart transplantation.
Results: A total of 194 patients with available pre- and post-procedural RVF assessment were included. Sixty-two (32%) presented an impaired RVF before procedure. Of them, 32% promptly normalized RVF following CRT. This occurred in parallel with a large improvement in pulmonary arterial pressure, mitral regurgitation, E/E’ ratio and diastolic function. Pre-implantation independent predictors of early RVF normalization were left-bundle branch block (p=0.034) and higher systolic blood pressure (p=0.026). Improvement in RVF was independently associated with a better long-term prognosis at multivariable analysis (HR 0.124; 95% CI 0.016-0.966, p=0.04), significantly increasing the accuracy of the long-term risk stratification compared to the baseline Cox model (p=0.04 at 48 months and p=0.048 at 96 months).
Conclusions: Acute normalization of RVF can be observed after CRT along with hemodynamic improvement, resulting as independent predictor of transplant-free survival.
Author Disclosures: D. Stolfo: None. E. Tonet: None. M. Merlo: None. G. Barbati: None. M. Gigli: None. B. Pinamonti: None. F. Ramani: None. M. Zecchin: None. G. Sinagra: None.
- © 2015 by American Heart Association, Inc.