Right ventricular function and survival following cardiac resynchronisation therapy

作者：Leong Darryl P; Hoke Ulas; Delgado Victoria; Auger Dominique; Witkowski Tomasz; Thijssen Joep; van Erven Lieselot; Bax Jeroen J; Schalij Martin J; Marsan Nina Ajmone^*

来源：Heart, 2013, 99(10): 722-728.

DOI：10.1136/heartjnl-2012-303076

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%26apos;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. %26lt;br%26gt;Design Retrospective observational study. %26lt;br%26gt;Setting Single tertiary centre. %26lt;br%26gt;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 %26lt;= 14 mm threshold indicating severe RV impairment. The primary endpoint was long-term all-cause mortality. %26lt;br%26gt;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%26lt;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%26lt;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. %26lt;br%26gt;Conclusions RV function is an independent predictor of long-term outcome following CRT.

• 出版日期2013-5