PT  - JOURNAL ARTICLE
AU  - Darryl P Leong
AU  - Ulas Höke
AU  - Victoria Delgado
AU  - Dominique Auger
AU  - Tomasz Witkowski
AU  - Joep Thijssen
AU  - Lieselot van Erven
AU  - Jeroen J Bax
AU  - Martin J Schalij
AU  - Nina Ajmone Marsan
TI  - Right ventricular function and survival following cardiac resynchronisation therapy
AID  - 10.1136/heartjnl-2012-303076
DP  - 2013 May 15
TA  - Heart
PG  - 722--728
VI  - 99
IP  - 10
4099  - http://heart.bmj.com/content/99/10/722.short
4100  - http://heart.bmj.com/content/99/10/722.full
SO  - Heart2013 May 15; 99
AB  - 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.