TORNA ALL’ELENCO

Prognostic role of right ventricular function in patients with heart failure undergoing cardiac resynchronization therapy in Heart Rhythm

2015
ASL Torino 3

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (18)Vedi tutti...

Botto GL

Stabile G

Padeletti L


et alii...

Abstract

Introduction: Since 20-40% of patients undergoing CRT do not respond to therapy, the identification of potential factors predicting response to CRT is a relevant research topic. Recent evidence suggests a possible association between right ventricular function and response to CRT. Methods: We analyzed data from the CRT MORE registry, about patients who received CRT according to current guidelines (NYHA class II-IV, optimal medical drug therapy, Left ventricular ejection fraction (LVEF) ? 35% and a QRS duration ? 120ms) from April 2013 to December 2013. Response to therapy was defined as an absolute improvement in LVEF ? 10% and as a decrease of at least 15% in left ventricular end-systolic volume (LVESV) on echocardiography at 6 months. Results: A total of 163 patients with a baseline estimation of tricuspid annular plane systolic excursion (TAPSE) and echocardiographic examination at 6 months follow up were considered for this analysis (age 70±10 years, male gender 71%, ischemic etiology 37%, history of atrial fibrillation 27%, NYHA class II in 46% of patients, spontaneous QRS duration 160±25ms, left bundle branch block 85%). Baseline echocardiographic parameters were: LVEF 28±6%, Mitral regurgitation grade ? 3 in 31% of patients, TAPSE 18.8±5mm, LVESV132±48 ml. On the basis of receiver operating characteristic curve analysis of TAPSE, the cutoff that best predicted improvement in LVEF (sensitivity 60%, specificity 61%) and LVESV (sensitivity 69%, specificity 52%) was 17mm. Stratifying patients according to the TAPSE, LVEF improved ? 10% in 49% of patients with TAPSE ?17mm (versus 30% in patients with TAPSE >17mm, p=0.019) and LVESV decreased ? 15% in 79% of patients with TAPSE ?17mm (versus 59%, p=0.008). At multivariate analysis, TAPSE ?17mm was independently associated with LVESV improvement (OR 2.26, 95% CI 1.1 to 4.6, p= 0.024), together with ischemic etiology (OR 0.44, 95% CI 0.22 to 0.89, p= 0.022). TAPSE ? 17mm was the only p

Keywords

parameters; mitral valve regurgitation; receiver operating characteristic; atrial fibrillation; heart left ventricle endsystolic volume; gender; examination; multivariate analysis; echocardiography; follow up; register; drug therapy; heart left ventricle ejection fraction; etiology; therapy; QRS interval; heart ventricle function; heart left bundle branch block; society; patient; cardiac resynchronization therapy; heart failure; human; heart rhythm; New York Heart Association class; male;