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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Tricuspid annular plane systolic excursion evaluation improves selection of cardiac resynchronization therapy
Francesco Cappelli1, Maria Cristina Porciani, Ilaria Ricceri
1Heart and Vessels Department, University of Florence, Florence, Italy. cappellifrancesco@inwind.it
Insights
Cardiac resynchronization therapy (CRT) improves both left and right heart function and structure. Measuring tricuspidal annular plane systolic excursion (TAPSE) can help select patients who will benefit most from CRT.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Cardiac resynchronization therapy (CRT) is known to benefit left ventricular (LV) remodeling.
- Limited data exist on CRT's effects on right ventricular (RV) function and remodeling.
Purpose of the Study:
- To investigate if CRT induces reverse remodeling in the RV.
- To determine if baseline RV function, assessed by tricuspidal annular plane systolic excursion (TAPSE), influences CRT response.
Main Methods:
- Echocardiography was performed on 192 patients before and 6 months after CRT.
- Evaluated parameters included TAPSE, LV and RV dimensions, functional parameters, and LV dyssynchrony index.
Main Results:
- 45% of patients were responders, showing significant LV end-systolic volume reduction.
- Responders had lower baseline TAPSE, larger LV volumes, and higher LV dyssynchrony.
- CRT responders exhibited RV reverse remodeling, increased TAPSE, and improved LV dyssynchrony.
Conclusions:
- CRT promotes reverse remodeling in both the RV and LV.
- Tricuspidal annular plane systolic excursion (TAPSE) is a valuable parameter for improving patient selection for CRT.
Background:
The beneficial effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) remodeling have been extensively described. Few data are available about the effects of CRT on right ventricular (RV) function and remodeling.
Hypothesis:
We hypothesized that CRT could also induce reverse remodeling in the right ventricle and that RV baseline functional status expressed as tricuspidal annular plane systolic excursion (TAPSE) could affect CRT response.
Methods:
Echocardiographic investigation was performed before and 6 months after CRT. In 192 patients, TAPSE, LV, and RV dimensions with functional parameters and LV dyssynchrony index were evaluated.
Results:
At 6 months' follow-up, 86 patients (45%) were responders to CRT according to at least 15% LV end-systolic volume reduction. Among baseline echocardiographic parameters, responders had significantly lower TAPSE, larger LV volumes, and higher LV dyssynchrony index. In responders, LV volume reduction, ejection fraction increase, and mitral regurgitation improvement were associated with RV dimensions reduction, increased TAPSE, and improved LV dyssynchrony. Receiver operating characteristic curve analysis showed that TAPSE, at 17 mm optimal cutoff, yielded 64% sensitivity and 60% specificity in predicting CRT response; similarly, LV dyssynchrony index, at 41.25 ms optimal cutoff, predicted CRT response with 60% sensitivity and 62% specificity. A subgroup analysis demonstrated that the coexistence of high TAPSE and high dyssynchrony index values increased probability of CRT response.
Conclusions:
Our results show that CRT induces RV and LV reverse remodeling and that CRT patient selection can be improved by simply measuring TAPSE value.
