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Plata-Corona JC, Solis-Jiménez F, Flores-Flamand M, Dattoli-García CA, Priego-Ranero ÁA, Sierra-Lara JD, Sierra-Fernández CR. Response predictors to cardiac resynchronization therapy in chronic heart failure: a 10-year-cardiovascular center experience. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:15-24. [PMID: 38507305 PMCID: PMC11160518 DOI: 10.24875/acm.22000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/25/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been established as an effective therapy for heart failure with reduced ejection fraction. Randomized clinical trials have shown its impact on mortality and HF hospitalizations, as well as improvement of symptoms and quality of life. OBJECTIVES Finding clinical, electrocardiographic, and echocardiographic variables that may predict the response to cardiac resynchronization therapy (CRT). METHODS We performed a single-center, observational, analytic, and retrospective study that included 102 patients with heart failure (HF) diagnosis who underwent CRT according to guideline-directed therapy from January 2010 to April 2020 in a third-level center. CRT response was defined as an improvement of New York Heart Association functional class in at least 1 category associated with a recovery of ≥ 5% in the left ventricular ejection fraction (LVEF). RESULTS Our study population was 102 patients of which 61 (59.8%) were men. The mean age at HF diagnosis was 54 ± 18.7 years. Ischemic heart disease was the etiology in 37 (36.3%) cases. Fifty-one (50%) patients were classified as responders. Responders had wider QRS, and lower LVEF and right ventricular fractional area change at baseline. After CRT, responders had a greater reduction of QRS duration, and improvement in LVEF, global longitudinal strain, and echocardiographic dyssynchrony parameters. Multivariate regression analysis showed that left bundle branch block (LBBB), left ventricular end-diastolic volume (LVEDV), tricuspid annular plane systolic excursion (TAPSE), and baseline difference of pre-ejection periods were predictors of a positive response to CRT in this population. CONCLUSIONS LBBB, TAPSE, LVEDV, and pre-ejection time difference are independent variables that can predict adequate response to CRT.
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Sidiropoulos G, Antoniadis A, Saplaouras A, Bazoukis G, Letsas ΚP, Karamitsos TD, Giannopoulos G, Fragakis N. Impact of baseline right ventricular function on the response to cardiac resynchronization therapy - A meta-analysis. Hellenic J Cardiol 2023; 73:61-68. [PMID: 36914097 DOI: 10.1016/j.hjc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Baseline right ventricular (RV) function potentially determines the response to Cardiac Resynchronization Therapy (CRT) but is not included in the current selection criteria. In this meta-analysis, we examined the value of echocardiographic indices of RV function as potential predictors of CRT outcomes in patients with standard indications for CRT. Baseline tricuspid annular plane systolic excursion was consistently higher in CRT responders, and this association appears independent of age, sex, ischemic etiology of heart failure, and baseline left ventricular ejection fraction. This proof-of-concept meta-analysis of observational data may justify a more detailed assessment of RV function as an additional component in the selection process of CRT candidates.
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Affiliation(s)
- Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Leoforos Papanikolaou, Pylaia, Thessaloniki, PK 57010, Greece.
| | - Antonios Antoniadis
- 3(rd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
| | - Athanasios Saplaouras
- Onassis Cardiac Surgery Center, Electrophysiology Department, Leoforos Andrea Syggrou 356, Athens, PK 17674, Greece.
| | - Georgios Bazoukis
- Department of Cardiology Larnaca General Hospital, Pandoras Street, Larnaca, PK 6301, Cyprus; Department of Basic and Clinical Sciences, University of Nicosia Medical School, 93 Agiou Nikolaou Street, Engomi, Nicosia, Cyprus.
| | - Κonstantinos P Letsas
- Onassis Cardiac Surgery Center, Electrophysiology Department, Leoforos Andrea Syggrou 356, PK 17674, Athens, Greece.
| | - Theodoros D Karamitsos
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Kiriakidi 1, Thessaloniki, PK 54636, Greece.
| | - Georgios Giannopoulos
- 3(rd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
| | - Nikolaos Fragakis
- 2(nd) Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, Thessaloniki, PK 54642, Greece.
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Zegard A, Okafor O, Moody W, Marshall H, Qiu T, Stegemann B, Beadle R, Leyva F. Right ventricular function and long-term clinical outcomes after cardiac resynchronization therapy: A cardiovascular magnetic resonance study. Pacing Clin Electrophysiol 2022; 45:1075-1084. [PMID: 35899803 DOI: 10.1111/pace.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT. METHODS In this retrospective study, we used cardiovascular magnetic resonance (CMR) to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation. RESULTS Among 243 patients (age: 70.3 ± 10.8 years [mean ±. SD]; 68.7% male; 121 [49.8%]) with ischemic cardiomyopathy and 122 (50.2%) with non-ischemic cardiomyopathy, 141 (58%) after CRT-defibrillation and 102 (42%) after CRT-pacing, 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from non-cardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and 4 (1.64%) had a left ventricular assist device. A total of 41 (16.9%) met the composite endpoint of sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction. CONCLUSIONS There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, UK
| | | | | | - Tian Qiu
- University Hospitals Birmingham, Birmingham, UK
| | | | - Roger Beadle
- South Warwickshire NHS Foundation Trust, Warwick, UK
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Galli E, Le Rolle V, Smiseth OA, Duchenne J, Aalen JM, Larsen CK, Sade EA, Hubert A, Anilkumar S, Penicka M, Linde C, Leclercq C, Hernandez A, Voigt JU, Donal E. Importance of Systematic Right Ventricular Assessment in Cardiac Resynchronization Therapy Candidates: A Machine Learning Approach. J Am Soc Echocardiogr 2021; 34:494-502. [PMID: 33422667 DOI: 10.1016/j.echo.2020.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite all having systolic heart failure and broad QRS intervals, patients screened for cardiac resynchronization therapy (CRT) are highly heterogeneous, and it remains extremely challenging to predict the impact of CRT devices on left ventricular function and outcomes. The aim of this study was to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular remodeling and prognosis of CRT candidates by the application of machine learning approaches. METHODS One hundred ninety-three patients with systolic heart failure receiving CRT according to current recommendations were prospectively included in this multicenter study. A combination of the Boruta algorithm and random forest methods was used to identify features predicting both CRT volumetric response and prognosis. Model performance was tested using the area under the receiver operating characteristic curve. The k-medoid method was also applied to identify clusters of phenotypically similar patients. RESULTS From 28 clinical, electrocardiographic, and echocardiographic variables, 16 features were predictive of CRT response, and 11 features were predictive of prognosis. Among the predictors of CRT response, eight variables (50%) pertained to right ventricular size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with particularly good prediction of both CRT response (area under the curve, 0.81; 95% CI, 0.74-0.87) and outcomes (area under the curve, 0.84; 95% CI, 0.75-0.93). An unsupervised machine learning approach allowed the identification of two phenogroups of patients who differed significantly in clinical variables and parameters of biventricular size and right ventricular function. The two phenogroups had significantly different prognosis (hazard ratio, 4.70; 95% CI, 2.1-10.0; P < .0001; log-rank P < .0001). CONCLUSIONS Machine learning can reliably identify clinical and echocardiographic features associated with CRT response and prognosis. The evaluation of both right ventricular size and functional parameters has pivotal importance for the risk stratification of CRT candidates and should be systematically performed in patients undergoing CRT.
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Affiliation(s)
- Elena Galli
- Université de Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Virginie Le Rolle
- Université de Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Otto A Smiseth
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jurgen Duchenne
- Department of Cardiovascular Disease, KU Leuven, Leuven, Belgium; Department of Cardiovascular Science, KU Leuven, Leuven, Belgium
| | - John M Aalen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Camilla K Larsen
- Institute for Surgical Research and Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Elif A Sade
- Department of Cardiology, Baskent University Hospital, Ankara, Turkey
| | - Arnaud Hubert
- Université de Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Smitha Anilkumar
- Non-Invasive Cardiac Laboratory, Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Alfredo Hernandez
- Université de Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Jens-Uwe Voigt
- Department of Cardiovascular Disease, KU Leuven, Leuven, Belgium; Department of Cardiovascular Science, KU Leuven, Leuven, Belgium
| | - Erwan Donal
- Université de Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
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Chen Y, Xue X, Gu Y, Xu H, Zhang X. Equilibrium radionuclide angiography compared with tissue doppler imaging for detection of right ventricular dyssynchrony and prediction of acute response to cardiac resynchronization therapy. Medicine (Baltimore) 2020; 99:e19296. [PMID: 32118744 PMCID: PMC7478515 DOI: 10.1097/md.0000000000019296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT). METHODS This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed. RESULTS Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ± 4.15% to 43.95 ± 6.88% and 14.00 ± 2.41% to 10.40 ± 1.67%, P < .05), whereas RV-T remained unchanged (50.10 ± 10.28 ms to 49.25 ± 13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity. CONCLUSION ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.
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Affiliation(s)
| | - Xue Xue
- Huai’an Hospital Affiliated to Xuzhou Medical College and Huai’an Second People's Hospital, Huai’an, Jiangsu, China
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Assessment of right ventriclular systolic function prior to cardiac resynchronization therapy: Does it make any difference? Indian Heart J 2017; 69:731-735. [PMID: 29174250 PMCID: PMC5717281 DOI: 10.1016/j.ihj.2017.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/15/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure (HF). Nearly 30% of candidates are inadequate responders. The benefit of patients with right sided heart failure from CRT is still a matter of debate. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response. Methods 94 patients with a mean age of 53.7 ± 14.6 years including 19 (20%) females, with advanced HF (EF < 35%, LBBB > 120 ms, or non-LBBB > 150 ms, with NYHA –III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD basal), maximum mid (RVD mid) transverse, maximum longitudinal (RVD long) diameters, TAPSE, fractional area change (FAC), and tricuspid lateral annular systolic velocity (S′), in addition to RV global longitudinal strain (RVGLS) measured by speckle tracking echocardiography, were done before CRT implantation and at the end of the follow up period (5.9 ± 1.2 months). Patients presenting with reductions of LVESV of >15% were termed volumetric responders for further statistical analysis. Results 63 (67%) cases were volumetric responders. Both groups were matched regarding demographic, clinical, ECG, and echocardiographic criteria apart from the RV significantly smaller transverse diameters and significantly better systolic function parameters in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters (33.6 ± 7.1 vs 40.7 ± 8.6, 21.4 ± 4.9 vs 27 ± 6.1, 68.3 ± 10.8 vs 81.2 ± 15, respectively), p < 0.01, together with significant improvement in RV systolic performance: FAC (47.7 ± 7.3 vs 40.9 ± 6.4), TAPSE (25.2 ± 4.6 vs 22.1 ± 4.9), S′ (15.3 ± 2.3 vs 12.8 ± 2.3), and GLS (26.1 ± 2.1 vs 18.5 ± 1.6), P < 0.01, compared to baseline readings. S' and GLS were the only independent predictors of CRT response by multivariate analysis. S′ >9 cm/s, and GLS >12.45% had 100% sensitivity and 70%, 99.7% specificity, respectively for prediction of response to CRT. Conclusions CRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.
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Predictors of response to cardiac resynchronization therapy: A prospective cohort study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abreu A, Oliveira M, Silva Cunha P, Santa Clara H, Santos V, Portugal G, Rio P, Soares R, Moura Branco L, Alves M, Papoila AL, Ferreira R, Mota Carmo M. Predictors of response to cardiac resynchronization therapy: A prospective cohort study. Rev Port Cardiol 2017; 36:417-425. [PMID: 28554585 DOI: 10.1016/j.repc.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 10/11/2016] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. AIMS To identify baseline characteristics that might influence echocardiographic response to CRT. METHODS AND RESULTS We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. CONCLUSION From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response. ClinicalTrials.gov identifier: NCT02413151.
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Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal.
| | - Mário Oliveira
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Pedro Silva Cunha
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Helena Santa Clara
- Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - Vanessa Santos
- Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - Guilherme Portugal
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Rui Soares
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Luísa Moura Branco
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Marta Alves
- Research Unit, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Ana Luísa Papoila
- Research Unit, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Rui Ferreira
- Cardiology Department, Hospital Santa Marta, Central Lisbon Hospital Center, CHLC, Lisbon, Portugal
| | - Miguel Mota Carmo
- CEDOC, Faculty of Medical Sciences, University Nova, Lisbon, Portugal
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Interplay between right ventricular mechanical dyssynchrony and cardiac resynchronization therapy in patients with nonischemic dilated cardiomyopathy. Nucl Med Commun 2017; 37:1016-23. [PMID: 27295307 DOI: 10.1097/mnm.0000000000000555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The effect of cardiac resynchronization therapy (CRT) on right ventricular ejection fraction (RVEF) and intraright ventricular dyssynchrony (IRVD) is questionable. Furthermore, it is unclear whether baseline IRVD and RVEF influences response to CRT. The aim of this study is to evaluate the effects of CRT on RVEF and IRVD and to investigate whether baseline IRVD and RVEF impacts response to CRT. PATIENTS AND METHODS Equilibrium radionuclide angiography and clinical evaluation were performed in 32 nonischemic dilated cardiomyopathy patients before and 3 months after CRT implantation. SD of the right ventricle mean phase angle expressed in degrees was used to quantify right intraventricular synchrony. RVEF was also evaluated. RESULTS There was no significant change in the RVEF and IRVD between the baseline and at 3 months after CRT equilibrium radionuclide angiography studies (RVEF: 40.5±10.6 vs. 40.4±10.4%, P=0.75; IRVD: 36.6±13.7 vs. 36.3±13.3°, P=0.35). Of 32 patients, 6/14 (43%) patients with baseline IRVD responded compared with 16/18 (89%) without baseline IRVD (P=0.02). CONCLUSION CRT did not cause any significant change in RVEF and IRVD. Patients with IRVD are less likely to respond to CRT.
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Ricci F, Mele D, Bianco F, Bucciarelli V, De Caterina R, Gallina S. Right heart-pulmonary circulation unit and cardiac resynchronization therapy. Am Heart J 2017; 185:1-16. [PMID: 28267462 DOI: 10.1016/j.ahj.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
Clinical response to cardiac resynchronization therapy (CRT) has been known for years to be highly variable, with a spectrum of responses from no change or even deterioration of cardiac function to spectacular improvements. In the plethora of clinical, echocardiographic, biohumoral, and electrophysiological predictors of response to CRT and postimplant issues besides patient selection, the role of right ventricular (RV) function has been largely overlooked. In reviewing current evidence, we noticed conflicting results between observational studies and randomized trials not only concerning the impact of baseline RV function on CRT efficacy but also on the effects of CRT on RV size and function. Hence, we aimed to provide a critical reappraisal of current knowledge and unresolved issues on the reciprocal interactions between RV function and CRT, shifting the spotlight on the concept of right heart pulmonary circulation unit and on the clinical and prognostic significance of impaired ventricular-arterial coupling reserve. In this viewpoint, we propose that (1) CRT should not be denied to potential candidate because of "isolated" RV dysfunction and (2) assessment of baseline right heart pulmonary circulation unit and its dynamic response to pharmacological stress should be considered in future studies, as well as in the preimplant evaluation of individual candidates among other clinical factors.
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Affiliation(s)
- Fabrizio Ricci
- Institute 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.
| | - Donato Mele
- Noninvasive Cardiac Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Francesco Bianco
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
| | | | | | - Sabina Gallina
- Institute of Cardiology, "G.d'Annunzio" University, Chieti, Italy
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Rapacciuolo A, Maffè S, Palmisano P, Ferraro A, Cecchetto A, D'Onofrio A, Solimene F, Musatti P, Paffoni P, Esposito F, Parravicini U, Agresta A, Botto GL, Malacrida M, Stabile G. Prognostic Role of Right Ventricular Function in Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. Clin Cardiol 2016; 39:640-645. [PMID: 27468173 DOI: 10.1002/clc.22574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stefano Maffè
- Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy
| | | | - Anna Ferraro
- Division of Cardiology, Rivoli Hospital, Rivoli, Italy
| | - Antonella Cecchetto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio D'Onofrio
- Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Francesco Solimene
- Casa di Cura Montevergine, Electrophysiology Department, Mercogliano, Italy
| | - Paola Musatti
- Fondazione Poliambulanza, Cardiology Department, Brescia, Italy
| | - Paola Paffoni
- Division of Cardiology, SS Trinità Hospital, Borgomanero, Italy
| | - Francesca Esposito
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Alessia Agresta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Luca Botto
- Hospital Sant'Anna, Electrophysiology and Cardiac Stimulation Department San Fermo della Battaglia, Italy
| | | | - Giuseppe Stabile
- Clinica Mediterranea, Laboratory of Electrophysiology, Naples, Italy
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Stolfo D, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G. Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomes. Eur J Heart Fail 2015; 18:205-13. [DOI: 10.1002/ejhf.450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/13/2015] [Accepted: 10/28/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Davide Stolfo
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Elisabetta Tonet
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Marco Merlo
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Giulia Barbati
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Marta Gigli
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Federica Ramani
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
| | - Gianfranco Sinagra
- Cardiovascular Department; ‘Ospedali Riuniti’ and University of Trieste; Trieste Italy
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Rasmussen JT, Thenappan T, Benditt DG, Weir EK, Pritzker MR. Is cardiac resynchronization therapy for right ventricular failure in pulmonary arterial hypertension of benefit? Pulm Circ 2015; 4:552-9. [PMID: 25610593 DOI: 10.1086/678470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/07/2014] [Indexed: 12/17/2022] Open
Abstract
Pulmonary arterial hypertension is a manifestation of a group of disorders leading to pulmonary vascular remodeling and increased pulmonary pressures. The right ventricular (RV) response to chronic pressure overload consists of myocardial remodeling, which is in many ways similar to that seen in left ventricular (LV) failure. Maladaptive myocardial remodeling often leads to intraventricular and interventricular dyssychrony, an observation that has led to cardiac resynchronization therapy (CRT) for LV failure. CRT has proven to be an effective treatment strategy in subsets of patients with LV failure resulting in improvement in LV function, heart failure symptoms, and survival. Current therapy for pulmonary arterial hypertension is based on decreasing pulmonary vascular resistance, and there is currently no effective therapy targeting the right ventricle or maladaptive ventricular remodeling in these patients. This review focuses on the RV response to chronic pressure overload, its effect on electromechanical coupling and synchrony, and how lessons learned from left ventricular cardiac resynchronization might be applied as therapy for RV dysfunction in the context of pulmonary arterial hypertension.
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Affiliation(s)
- Jason T Rasmussen
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Thenappan Thenappan
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - David G Benditt
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - E Kenneth Weir
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc R Pritzker
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Gómez O, Sitges M, Bijnens B, Gratacós E. A fetal cardiovascular score to predict infant hypertension and arterial remodeling in intrauterine growth restriction. Am J Obstet Gynecol 2014; 210:552.e1-552.e22. [PMID: 24368136 DOI: 10.1016/j.ajog.2013.12.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/29/2013] [Accepted: 12/19/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Intrauterine growth restricted (IUGR) fetuses experience cardiovascular remodeling that persists into infancy and has been related to cardiovascular outcomes in adulthood. Hypertension in infancy has been demonstrated to be a strong risk factor for later cardiovascular disease. Close monitoring together with dietary interventions have shown to improve cardiovascular health in hypertensive children; however, not all IUGR infants show increased blood pressure. We evaluated the potential of fetal echocardiography for predicting hypertension and arterial remodeling in 6-month-old IUGR infants. STUDY DESIGN One hundred consecutive IUGR and 100 control fetuses were observed into infancy. Fetal assessment included perinatal Doppler imaging, cardiac morphometry, ejection fraction, cardiac output, isovolumic relaxation time (IVRT), tricuspid annular-plane systolic excursion (TAPSE), and tissue Doppler imaging. Infant hypertension and arterial remodeling were defined as mean blood pressure of >95th percentile together with aortic intima-media thickness of >75th percentile at 6 months of age. Odds ratio were obtained for fetal parameters that were associated with infant outcomes. RESULTS Fetal TAPSE, right sphericity index, IVRT, and cerebroplacental ratio were the strongest predictors for postnatal vascular remodeling. A cardiovascular risk score that was based on fetal TAPSE, cerebroplacental ratio, right sphericity index, and IVRT was highly predictive of infant hypertension and arterial remodeling (area under the curve, 0.87; 95% confidence interval, 0.79-0.93; P < .001). CONCLUSION Fetal echocardiographic parameters identify a high-risk group within the IUGR fetuses who could be targeted for early screening of blood pressure and other cardiovascular risk factors and for promoting healthy diet and physical exercise.
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Affiliation(s)
- Mónica Cruz-Lemini
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Fátima Crispi
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Brenda Valenzuela-Alcaraz
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Francesc Figueras
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Olga Gómez
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain
| | - Marta Sitges
- Department of Cardiology, Institut Clínic del Tòrax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Bart Bijnens
- ICREA-Universitat Pompeu Fabra, Barcelona, Spain
| | - Eduard Gratacós
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona and Centro de Investigación Biomédica en Red en Enfermedades Raras, Barcelona, Spain.
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Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Sitges M, Gómez O, Bijnens B, Gratacós E. Value of annular M-mode displacement vs tissue Doppler velocities to assess cardiac function in intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:175-181. [PMID: 23280816 DOI: 10.1002/uog.12374] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the ability of two different methods for longitudinal annular motion measurement, M-mode and tissue Doppler imaging (TDI), to demonstrate cardiac dysfunction in intrauterine-growth-restricted (IUGR) fetuses. METHODS Cardiac longitudinal annular motion in the basal free wall of the left ventricle (mitral annulus), interventricular septum and tricuspid annulus was assessed in 23 early-onset IUGR cases and 43 controls by TDI (annular peak velocities) and M-mode (displacement). RESULTS All annular parameters were significantly decreased in the IUGR group with respect to controls using both methods. M-mode showed a trend towards equal performance as classifier between cases and controls, as compared to TDI, mainly in the tricuspid annulus. CONCLUSIONS Both M-mode and TDI demonstrate annular motion changes and consequently cardiac dysfunction in IUGR fetuses. M-mode imaging is simpler to perform and could be as sensitive as TDI for detecting subtle changes.
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Affiliation(s)
- M Cruz-Lemini
- Department of Maternal-Fetal Medicine, Fetal and Perinatal Medicine Research Group Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Barcelona, Spain
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Right Ventricular Function Is a Determinant of Long-Term Survival after Cardiac Resynchronization Therapy. J Am Soc Echocardiogr 2013; 26:706-13. [DOI: 10.1016/j.echo.2013.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Indexed: 11/20/2022]
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Agacdiken A, Celikyurt U, Sahin T, Karauzum K, Vural A, Ural D. Neutrophil-to-lymphocyte ratio predicts response to cardiac resynchronization therapy. Med Sci Monit 2013; 19:373-7. [PMID: 23686301 PMCID: PMC3663578 DOI: 10.12659/msm.883915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte (N/L) ratio has been associated with adverse outcomes in patients with acute coronary syndromes and increased risk for long-term mortality in patients with acute decompensated heart failure. We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio on response to cardiac resynchronization therapy (CRT). MATERIAL AND METHODS Seventy consecutive patients (mean age 58 ± 13 years; 40 men) undergoing CRT were included in the study. Hematological and echocardiographic parameters were measured before and 6 months after CRT. Echocardiographic response to CRT was defined as a ≥ 15% reduction in left ventricular end-systolic volume at 6-month follow-up. RESULTS After 6 months of CRT, 49 (70%) patients were responders. After 6 months, left ventricular ejection fraction (LVEF) had significantly increased, from 21 ± 7% to 34 ± 11% in responder patients (p = 0.001). N/L ratio decreased significantly, from 2.4 ± 1 to 2.1 ± 0.7 in responders (p = 0.04). In multivariate analysis, significant associates of echocardiographic response to CRT was evaluated adjusting for age, etiology of cardiomyopathy, baseline LVEF, New York Heart Association functional class, C-reactive protein, and baseline N/L ratio. Baseline N/L ratio was the only predictor of response to CRT (OR 1.506, 95% CI, 1.011-2.243, p = 0.035). CONCLUSIONS N/L ratio at baseline could help to identify patients with response to CRT.
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Affiliation(s)
- Aysen Agacdiken
- Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
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Interplay Between Right Ventricular Function and Cardiac Resynchronization Therapy. J Am Coll Cardiol 2013; 61:2153-60. [DOI: 10.1016/j.jacc.2013.02.049] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/24/2013] [Accepted: 02/17/2013] [Indexed: 11/23/2022]
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Función longitudinal del ventrículo derecho estimada por el desplazamiento sistólico del anillo tricúspide (TAPSE) en 557 pacientes sanos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70147-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Valzania C, Gadler F, Boriani G, Eriksson MJ. Changes in global longitudinal strain during rest and exercise in patients treated with cardiac resynchronization therapy. Clin Physiol Funct Imaging 2012; 32:310-6. [DOI: 10.1111/j.1475-097x.2012.01128.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Cinzia Valzania
- Cardiovascular Department, S. Orsola-Malpighi Hospital; University of Bologna; Bologna; Italy
| | | | - Giuseppe Boriani
- Cardiovascular Department, S. Orsola-Malpighi Hospital; University of Bologna; Bologna; Italy
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Vitarelli A, Franciosa P, Nguyen BL, Capotosto L, Ciccaglioni A, Conde Y, Iorio G, De Curtis G, Caranci F, Vitarelli M, Lucchetti P, Dettori O, De Cicco V. Additive Value of Right Ventricular Dyssynchrony Indexes in Predicting the Success of Cardiac Resynchronization Therapy: A Speckle-Tracking Imaging Study. J Card Fail 2011; 17:392-402. [DOI: 10.1016/j.cardfail.2010.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 11/24/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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