Antonio Rapacciuolo1, Stefano Maffè2, Pietro Palmisano3, Anna Ferraro4, Antonella Cecchetto5, Antonio D'Onofrio6, Francesco Solimene7, Paola Musatti8, Paola Paffoni2, Francesca Esposito1, Umberto Parravicini2, Alessia Agresta1, Giovanni Luca Botto9, Maurizio Malacrida10, Giuseppe Stabile11. 1. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 2. Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy. 3. Cardiology Unit, Card. G. Panico Hospital, Tricase, Italy. 4. Division of Cardiology, Rivoli Hospital, Rivoli, Italy. 5. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 6. Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy. 7. Casa di Cura Montevergine, Electrophysiology Department, Mercogliano, Italy. 8. Fondazione Poliambulanza, Cardiology Department, Brescia, Italy. 9. Hospital Sant'Anna, Electrophysiology and Cardiac Stimulation Department San Fermo della Battaglia, Italy. 10. Cardiac Rhythm Management, Boston Scientific Italia, Milan, Italy. 11. Clinica Mediterranea, Laboratory of Electrophysiology, Naples, Italy.
Abstract
BACKGROUND: Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic. HYPOTHESIS: There is a possible association between right ventricular function and response to CRT. METHODS: We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months. RESULTS: The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012). CONCLUSIONS: Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure.
BACKGROUND: Because 20% to 40% of patients undergoing cardiac resynchronization therapy (CRT) do not respond to it, identification of potential factors predicting response is a relevant research topic. HYPOTHESIS: There is a possible association between right ventricular function and response to CRT. METHODS: We analyzed 227 patients from the Cardiac Resynchronization Therapy Modular Registry (CRT-MORE) who received CRT according to current guidelines from March to December 2013. Response to therapy was defined as a decrease of ≥15% in left ventricular end-systolic volume (LVESV) at 6 months. RESULTS: The tricuspid annular plane systolic excursion (TAPSE) value that best predicted improvement in LVESV (sensitivity 68%, specificity 54%) was 17 mm. Stratifying patients according to TAPSE, LVESV decreased ≥15% in 78% of patients with TAPSE >17 mm (vs 59% in patients with TAPSE ≤17 mm; P = 0.006). At multivariate analysis, TAPSE >17 mm was independently associated with LVESV improvement (odds ratio: 1.97, 95% confidence interval: 1.03-3.80, P < 0.05), together with ischemic etiology (odds ratio: 0.39, 95% confidence interval: 0.20-0.75, P < 0.01). These results were confirmed for New York Heart Association class III to IV patients (79% echocardiographic response rate in patients with TAPSE >17 mm vs 55% in patients with TAPSE <17 mm; P = 0.012). CONCLUSIONS: Baseline signs of right ventricular dysfunction suggest possible remodeling after CRT. A TAPSE value of 17 mm was identified as a good cutoff for predicting a better response to CRT in patients with both mildly symptomatic and severe heart failure.
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