Baseline Right Ventricular Dysfunction Predicts Worse Outcomes in Patients Undergoing Cardiac Resynchronization
Divyang Patel1, Kevin Trulock1, Anirudh Kumar1
1Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Journal of Cardiac Failure
|December 28, 2019
Summary
Right ventricular dysfunction at cardiac resynchronization therapy (CRT) implant predicts worse survival and CRT response in heart failure patients. This highlights RV function as a key factor in CRT outcomes.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) improves survival in systolic heart failure patients with wide QRS duration and left-bundle-branch-block.
- Limited data exists on CRT outcomes stratified by baseline right ventricular (RV) function.
Purpose of the Study:
- To investigate the impact of baseline right ventricular (RV) function on cardiac resynchronization therapy (CRT) response and survival.
- To determine if RV dysfunction is an independent predictor of outcomes in CRT patients.
Main Methods:
- Retrospective review of 777 patients undergoing CRT implantation (2003-2011) with heart failure and specific echocardiographic criteria.
- Patients categorized into Normal RV (mild dysfunction) and RV DYSFXN (moderate-to-severe dysfunction) groups based on echocardiography.
- Survival analysis (time to death, LVAD implant, or heart transplant) and multivariable Cox regression were performed.
Main Results:
- CRT response was significantly lower in the RV DYSFXN group (56%) compared to the Normal RV group (67%).
- Kaplan-Meier analysis revealed significantly greater survival in the Normal RV group versus the RV DYSFXN group (P < .001).
- RV DYSFXN was independently associated with worse survival (HR 1.41) and lower CRT response (HR 0.66).
Conclusions:
- Baseline right ventricular (RV) dysfunction is a significant predictor of adverse outcomes in patients receiving cardiac resynchronization therapy (CRT).
- RV dysfunction is associated with poorer left ventricular remodeling and reduced survival post-CRT implantation.
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