Amaar Ujeyl1, Keiichi Inada1, Katja Hillmann2, Peter Wohlmuth3, Mahoto Kato1, Usha Tedrow1, Lynne W Stevenson4, William G Stevenson1. 1. Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Economics, University of Hamburg, Hamburg, Germany. 3. ProResearch, Asklepios Klinik Hamburg, Germany. 4. Cardiovascular Division and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: lstevenson@partners.com.
Abstract
OBJECTIVES: This study sought to determine the relevance of echocardiographic assessment focusing on right ventricular (RV) function to estimate prognosis in patients with heart failure (HF) and low left ventricular ejection fraction (LVEF) after ablation of ventricular tachycardia (VT). BACKGROUND: Recurrent VT is a marker of increased mortality in HF. Decision making remains challenging as some patients have a poor outcome despite successful catheter ablation of VT due to progressive biventricular HF. METHODS: Retrospective analysis was performed on data from 320 consecutive patients with HF and LVEF ≤40% who underwent ablation for recurrent VT between 1999 and 2008. Baseline clinical and echocardiographic data were analyzed in relation to survival. RESULTS: Among the 320 patients included, the mean age was 63 years, and 86% were male. During follow-up (median: 36 months) 127 patients (40%) died. RV dysfunction (hazard ratio [HR]: 1.4) and tricuspid regurgitation (TR) (HR: 1.7), together with age, New York Heart Association (NYHA) class, and serum creatinine, were independent predictors of death in a Cox regression model. Mortality was more than 2-fold higher in patients with at least moderate RV dysfunction and TR (HR: 2.6; p < 0.001). In patients with at least moderate RV dysfunction, TR, and estimated pulmonary arterial pressure ≥45 mm Hg, mortality was 61% at 2 years, compared with 16% in patients with good RV function without pulmonary hypertension (p < 0.0001). CONCLUSIONS: Despite low LVEF, patients with recurrent VT who had good RV function without elevated pulmonary pressures had a good prognosis after VT ablation. RV dysfunction, TR, and elevated pulmonary pressures identified a high-risk group of VT survivors in whom additional interventions may be necessary to improve survival.
OBJECTIVES: This study sought to determine the relevance of echocardiographic assessment focusing on right ventricular (RV) function to estimate prognosis in patients with heart failure (HF) and low left ventricular ejection fraction (LVEF) after ablation of ventricular tachycardia (VT). BACKGROUND: Recurrent VT is a marker of increased mortality in HF. Decision making remains challenging as some patients have a poor outcome despite successful catheter ablation of VT due to progressive biventricular HF. METHODS: Retrospective analysis was performed on data from 320 consecutive patients with HF and LVEF ≤40% who underwent ablation for recurrent VT between 1999 and 2008. Baseline clinical and echocardiographic data were analyzed in relation to survival. RESULTS: Among the 320 patients included, the mean age was 63 years, and 86% were male. During follow-up (median: 36 months) 127 patients (40%) died. RV dysfunction (hazard ratio [HR]: 1.4) and tricuspid regurgitation (TR) (HR: 1.7), together with age, New York Heart Association (NYHA) class, and serum creatinine, were independent predictors of death in a Cox regression model. Mortality was more than 2-fold higher in patients with at least moderate RV dysfunction and TR (HR: 2.6; p < 0.001). In patients with at least moderate RV dysfunction, TR, and estimated pulmonary arterial pressure ≥45 mm Hg, mortality was 61% at 2 years, compared with 16% in patients with good RV function without pulmonary hypertension (p < 0.0001). CONCLUSIONS: Despite low LVEF, patients with recurrent VT who had good RV function without elevated pulmonary pressures had a good prognosis after VT ablation. RV dysfunction, TR, and elevated pulmonary pressures identified a high-risk group of VT survivors in whom additional interventions may be necessary to improve survival.
Authors: John J Ryan; Jessica Huston; Shelby Kutty; Nathan D Hatton; Lindsay Bowman; Lian Tian; Julia E Herr; Amer M Johri; Stephen L Archer Journal: Can J Cardiol Date: 2015-01-29 Impact factor: 5.223