Right ventricular function and survival following cardiac resynchronisation therapy
- Darryl P Leong1,2,
- Ulas Höke1,
- Victoria Delgado1,
- Dominique Auger1,
- Tomasz Witkowski1,
- Joep Thijssen1,
- Lieselot van Erven1,
- Jeroen J Bax1,
- Martin J Schalij1,
- Nina Ajmone Marsan1
- 1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
- 2The Discipline of Medicine, University of Adelaide and Flinders University, Adelaide, Australia
- Correspondence to Dr Nina Ajmone Marsan, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, The Netherlands;
- Received 17 September 2012
- Revised 23 November 2012
- Accepted 27 November 2012
- Published Online First 12 January 2013
Objectives Right ventricular (RV) function is an important prognostic marker in heart failure. However, its impact on all-cause mortality following cardiac resynchronisation therapy (CRT) independent of confounding factors has not been evaluated. Furthermore, evidence concerning the effect of CRT on RV function is limited. The study's aims were to: (1) assess the prognostic importance of RV function among CRT recipients, and (2) characterise RV functional change following CRT and its determinants.
Design Retrospective observational study.
Setting Single tertiary centre.
Patients A total of 848 CRT recipients (median age 65 years, 78% male, 60% ischaemic) underwent echocardiography before and 6 months after CRT. RV function was evaluated using tricuspid annular plane systolic excursion (TAPSE), with a ≤14 mm threshold indicating severe RV impairment. The primary endpoint was long-term all-cause mortality.
Results Significant baseline RV dysfunction was observed in 286 (34%) individuals. After a median 44 months, 288 deaths occurred. RV impairment was associated with a greater incidence of all-cause mortality (log-rank p<0.001). Independent predictors of this endpoint were functional class, ischaemic aetiology, diabetes, atrial fibrillation, renal dysfunction, bigger left ventricular (LV) end-systolic volume, less LV dyssynchrony and reduced TAPSE. Importantly, TAPSE added prognostic value to these recognised prognostic parameters (likelihood-ratio test p<0.001). Furthermore, improvement in RV function after CRT was independent of the improvement in LV systolic function but significantly associated with the improvement in LV diastolic function. Importantly, a favourable RV functional response to CRT was associated with superior survival.
Conclusions RV function is an independent predictor of long-term outcome following CRT.