Remote past left ventricular function before chronic right ventricular pacing predicts responses to cardiac...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Long-term right ventricular pacing (RVP) can lead to heart failure (HF).
• Patients initially ineligible for cardiac resynchronization therapy (CRT) may develop HF after RVP and become candidates for CRT upgrade.
• Predicting CRT response in this specific patient group is crucial for optimizing treatment.

Purpose of the Study:

• To identify predictors of response to CRT upgrade in patients with HF following long-term RVP.
• To evaluate the utility of remote past left ventricular ejection fraction (RP-LVEF) and conventional dyssynchrony indexes in predicting CRT response.

Main Methods:

• Twenty-five patients with HF post-long-term RVP underwent CRT upgrade.
• Echocardiography was performed pre-CRT and 6 months post-CRT.
• RP-LVEF was retrospectively collected; responders were defined by a ≥15% reduction in LV end-systolic volume (LVESV).

Main Results:

• Responders showed significantly higher RP-LVEF (53.6%) compared to non-responders (31.4%).
• RP-LVEF strongly correlated with LVESV reduction post-CRT (P < 0.001).
• An RP-LVEF cutoff of 43.5% predicted CRT response with 78% sensitivity and 100% specificity.

Conclusions:

• Remote past left ventricular ejection fraction (RP-LVEF) ≥ 43.5% is a strong predictor of positive response to CRT upgrade in patients with HF after long-term RVP.
• Traditional dyssynchrony indexes did not effectively predict CRT response in this cohort.