Right heart-pulmonary circulation unit and cardiac resynchronization therapy.
Fabrizio Ricci1, Donato Mele2, Francesco Bianco3
1Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy; Department of Neuroscience and Imaging and ITAB-Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy.
American Heart Journal
|March 8, 2017
Summary
Right ventricular (RV) function is crucial for cardiac resynchronization therapy (CRT) response. This review highlights the importance of assessing the right heart-pulmonary circulation unit for better CRT outcomes.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Clinical response to cardiac resynchronization therapy (CRT) is highly variable.
- The role of right ventricular (RV) function in CRT efficacy is often overlooked.
- Conflicting evidence exists regarding the impact of baseline RV function on CRT outcomes.
Purpose of the Study:
- To critically reappraise knowledge on RV function and CRT interactions.
- To emphasize the significance of the right heart-pulmonary circulation unit.
- To explore the prognostic value of impaired ventricular-arterial coupling reserve.
Main Methods:
- Review of current evidence on RV function and CRT.
- Analysis of observational studies and randomized trials.
- Focus on the right heart-pulmonary circulation unit concept.
Main Results:
- RV function significantly influences CRT response.
- CRT can affect RV size and function, with mixed study results.
- Impaired ventricular-arterial coupling reserve has clinical and prognostic implications.
Conclusions:
- CRT should not be withheld due to isolated RV dysfunction.
- Pre-implant evaluation should include assessment of the right heart-pulmonary circulation unit and its dynamic response.
- Further research is needed on RV function's role in CRT.
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