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Sidiropoulos G, Karakasis P, Antoniadis A, Saplaouras A, Karamitsos T, Fragakis N. The Effect of Cardiac Resynchronization Therapy on Right Ventricular Function: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4173. [PMID: 39064212 PMCID: PMC11277751 DOI: 10.3390/jcm13144173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Right ventricular (RV) failure is an important predicting factor regarding overall and event-free survival regardless of baseline left ventricular (LV) function in patients with severe heart failure (HF). Previous studies have indicated that cardiac resynchronization therapy (CRT) improves LV and RV reverse remodeling in patients with systolic dyssynchrony within the left ventricle. However, there is conflicting evidence regarding the role of CRT in RV function. The aim of this systematic review and meta-analysis was to examine the implications of CRT on RV function indices. Methods: A systematic literature search was conducted using the MedLine and EMBASE databases and the Cochrane Library from their inception until 18 March 2024. Eligible were studies providing information on RV function indices, both at baseline and after CRT. Evidence was summarized using random-effects meta-analytic models. Results: In total, 30 studies were deemed eligible. CRT resulted in a significant improvement in right ventricular fractional area change (mean difference (MD) 5.11%, 95% confidence interval (CI) 2.83 to 7.39), tricuspid annular plane systolic excursion (TAPSE, MD 1.63 mm, 95% CI 1.10 to 2.16), and myocardial systolic excursion velocity (MD 1.85 cm/s, 95% CI 1.24 to 2.47) as well as a significant decrease in pulmonary artery systolic pressure (MD -6.24 mmHg, 95% CI -8.32 to -4.16). A non-significant effect was observed on TAPSE to PASP ratio and right ventricular global longitudinal strain. Conclusions: Our meta-analysis demonstrates that CRT is associated with a significant improvement in echocardiographic parameters of RV function. Further investigation is necessary to elucidate how these changes, both independently and in conjunction with LV improvement, impact patients' long-term prognosis, and to identify the specific patient populations expected to derive the greatest benefit.
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Affiliation(s)
- Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Leoforos Papanikolaou, PK 57010 Thessaloniki, Greece;
| | - Paschalis Karakasis
- 2nd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, PK 54642 Thessaloniki, Greece;
| | - Antonios Antoniadis
- 3rd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, PK 54642 Thessaloniki, Greece;
| | - Athanasios Saplaouras
- Onassis Cardiac Surgery Center, Electrophysiology Department, Leoforos Andrea Syggrou 356, PK 17674 Athens, Greece;
| | - Theodoros Karamitsos
- 1st Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Kiriakidi 1, PK 54636 Thessaloniki, Greece;
| | - Nikolaos Fragakis
- 2nd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, PK 54642 Thessaloniki, Greece;
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Dawood M, Elsharkawy E, Nawar M, Sanhoury M. Right Ventricular Response to Cardiac Resynchronization Therapy: A Three-Dimensional and Speckle Tracking Echocardiographic Study. Am J Cardiol 2023; 205:150-161. [PMID: 37598600 DOI: 10.1016/j.amjcard.2023.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/23/2023] [Indexed: 08/22/2023]
Abstract
Cardiac resynchronization therapy (CRT) induces left ventricle reverse remodeling; however, its effects on right ventricular (RV) volumes and function were not well described. This study aimed to assess the effects of CRT on RV. Of 112 patients, 63 enrolled with a mean age of 62.77 ± 7.23 years, including 40 males (63.5%). All patients met criteria for CRT implantation and were followed at 3-month and 6-month intervals. Standard 2-dimensional/3-dimensional (3D) echocardiography and speckle-tracking analyses were conducted for assessment of LV and left atrium (LA). RV maximum diameters, tricuspid lateral annular systolic velocity, tricuspid annular plane systolic excursion, fractional area change, RV global (RV 4-chamber strain (RV4CSL), and RV free wall strain (RVFWSL), in addition to 3D echocardiographic assessment of RV, were done before CRT implantation and at follow-up visits. Mean follow-up period was 6.76 ± 1.25 months. A total of 48 patients (76.2%) were LV responders (LVR) whereas the rest were nonresponders (LVNR). Both groups had similar baseline characteristics, risk factors, device implantation, and programming values. Only LVR had significant reduction in RV basal diameter, together with significant improvement of RV systolic performance: systolic velocity, fractional area change, RV4CSL, RVFWSL, and 3D-derived RV volumes and ejection fraction, compared with baseline values. In addition, pulmonary arterial systolic pressure decreased in LVR with reduction of tricuspid regurgitation severity. LV response, percentage change of RV4CSL, LA end-systolic volume index, and LA emptying fraction at 3-month follow-up were the most independent predictors of RV response by multivariate analysis. Reduced left ventricular end-systolic volume >13.5% had 92.3% sensitivity and 81.8% specificity. In conclusion, CRT-induced RV reverse remodeling and improved RV-arterial coupling. These effects were associated with left side response to CRT.
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Affiliation(s)
- Moustafa Dawood
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt.
| | - Eman Elsharkawy
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Moustafa Nawar
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Sanhoury
- Department of Cardiology and Angiology, Faculty of Medicine, Alexandria University, Egypt
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Sadeghian H, Kazemisaied A, Rezvanfard M, Jalali A, Sadeghian A, Ashraf H, Semnani F, Raeini AG. Improved Right Ventricular Systolic Function After Cardiac Resynchronization Therapy in Patients With Heart Failure. Tex Heart Inst J 2022; 49:e207499. [PMID: 36228327 PMCID: PMC9632399 DOI: 10.14503/thij-20-7499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Since the introduction of cardiac resynchronization therapy (CRT) to improve left ventricular function, the effect of CRT on the right ventricle in patients with heart failure has not been well described. METHODS We evaluated the effect of CRT on right ventricular systolic function in 20 patients (80% men; mean [SD] age, 58.5 [9.8] y) with cardiomyopathy and right ventricular systolic dysfunction (New York Heart Association class III or IV, left ventricular ejection fraction ≤35%, and QRS interval ≥120 ms). The median follow-up time was 15 months. Right ventricular systolic function, defined as a tricuspid annular plane systolic excursion (TAPSE) index of 16 mm or less, was evaluated in patients before and after CRT. RESULTS Twelve (60%) patients had ischemic cardiomyopathy, and 12 (60%) patients had left bundle branch block detected using surface electrocardiogram. The mean (SD) QRS duration was 160.5 (24.4) ms. From before CRT to the time of follow-up after CRT, the mean (SD) ejection fraction increased significantly from 22.5% (5.6%) to 29.4% (7.4%) (P < .001). The mean (SD) TAPSE index also increased significantly from 13.70 (1.78) mm to 16.50 (4.77) mm (P = .018). Eleven (55%) patients showed improved right ventricular systolic function (TAPSE ≥16 mm) after CRT. Patients with a favorable right ventricular response to CRT were significantly older (64.6 [8.2] y vs 53.6 [8.4] y, respectively) and more likely to have nonischemic origin of cardiomyopathy than were patients with unimproved right ventricular function (66.7% vs 18.2%, respectively). CONCLUSION Our findings indicate that CRT is associated with improved right ventricular systolic function in patients with heart failure and right ventricular systolic dysfunction. Patients with nonischemic heart disease more often show improved right ventricular function after CRT.
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Affiliation(s)
- Hakimeh Sadeghian
- Echocardiography Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemisaied
- Electrophysiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Rezvanfard
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghian
- Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Haleh Ashraf
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farbod Semnani
- Student's Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Baseline Right Ventricular Dysfunction Predicts Worse Outcomes in Patients Undergoing Cardiac Resynchronization Therapy Implantation. J Card Fail 2020; 26:227-232. [DOI: 10.1016/j.cardfail.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 02/02/2023]
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Bragança B, Trêpa M, Santos R, Silveira I, Fontes-Oliveira M, Sousa MJ, Reis H, Torres S, Santos M. Echocardiographic Assessment of Right Ventriculo-arterial Coupling: Clinical Correlates and Prognostic Impact in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy. J Cardiovasc Imaging 2020; 28:109-120. [PMID: 32052609 PMCID: PMC7114448 DOI: 10.4250/jcvi.2019.0094] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Right ventriculo-arterial coupling (RV-PA) can be estimated by echocardiography using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) and it has prognostic value in the general heart failure (HF) population. We aimed to study the clinical correlates and prognostic value of RV-PA in HF patients undergoing cardiac resynchronization therapy (CRT). METHODS We retrospectively studied 70 HF patients undergoing CRT implantation. RESULTS RV-PA coupling was estimated by TAPSE/PASP ratio using baseline echocardiography. Non-response to CRT was defined as improvement of left ventricular ejection fraction < 5% in a follow-up echo 6-12 months after CRT. Those with lower TAPSE/PASP ratios (worse RV-PA coupling) had higher NT-proBNP concentrations and increased E/e' ratio. TAPSE/PASP ratio and PASP, but not TAPSE, predicted nonresponse to CRT with TAPSE/PASP ratio showing the best discriminative ability with a sensitivity of 76% and specificity of 71%. Among these parameters, PASP independently predicted all-cause mortality. CONCLUSIONS RV-PA coupling estimated by TAPSE/PASP ratio was associated with established prognostic markers in HF. It numerically outperformed PASP and TAPSE in predicting the response to CRT. Our data suggest that this simple and widely available echocardiographic parameter conveys significant pathophysiological and prognostic meaning in HF patients undergoing CRT.
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Affiliation(s)
- Bruno Bragança
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Maria Trêpa
- Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Raquel Santos
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Inês Silveira
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | - Hipólito Reis
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mário Santos
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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Markel F, Paech C, Gebauer RA. Is right ventricular resynchronization the key to both right and left ventricular remodeling? HeartRhythm Case Rep 2019; 6:20-22. [PMID: 31956496 PMCID: PMC6962746 DOI: 10.1016/j.hrcr.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Franziska Markel
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Christian Paech
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
| | - Roman Antonin Gebauer
- Department for Pediatric Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
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Cotarlan V, Johnson F, Goerbig-Campbell J, Light-McGroary K, Inampudi C, Franzwa J, Jenn K, Johnson C, Tandon R, Tahir R, Nabeel Y, Emerenini U, Giudici M. Usefulness of Cardiac Resynchronization Therapy in Patients With Continuous Flow Left Ventricular Assist Devices. Am J Cardiol 2019; 123:93-99. [PMID: 30539750 DOI: 10.1016/j.amjcard.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
The benefit of cardiac resynchronization therapy in patients supported by a left ventricular assist device (LVAD) is unknown. There are currently no guidelines regarding the continuation, discontinuation or pacemaker (PM) settings post-LVAD implant. The aim of the study was to assess the hemodynamic benefit of biventricular (BiV) pacing in LVAD patients. We studied 22 patients supported by LVADs (age 62 ± 9, 21 males) who had received a BiV PM before LVAD implant. A total of 123 complete sets of hemodynamics were obtained during BiV pacing (n = 54), right ventricular (RV) pacing (n = 54), and intrinsic rhythm (n = 15). There were no significant differences in right atrial (RA) pressure, mean pulmonary artery pressure (mPA), PCWP, cardiac output, PA saturation (PASat) and right ventricular stroke work index between BiV and RV pacing. Hemodynamics obtained during intrinsic rhythm in 15 non-PM-dependent patients were not significantly different compared with those obtained during BiV or RV pacing. Furthermore, hemodynamics were similar at different heart rates ranging 50 to 110 beats/min. Right ventricular stroke work index was significantly lower at the highest heart rate compared with baseline and lowest heart rates suggesting decreased RV performance at higher heart rate. In conclusion, BiV pacing does not have any acute hemodynamic benefit compared with RV pacing or intrinsic rhythm in LVAD patients. A lower heart rate may confer better RV performance.
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Right ventricular failure management. Curr Opin Cardiol 2018; 34:213-217. [PMID: 30575646 DOI: 10.1097/hco.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Review recent advances in the diagnosis and management of right ventricular (RV) failure. RECENT FINDINGS Temporary and durable device-based management of RV failure has emerging applications. SUMMARY Research advances and clinical management in RV failure have been limited by a lack of consensus on a universal definition. Echocardiographic and cardiac MRI-based predictors of RV failure are imperfect. Combinations of hemodynamic and imaging variables may have better predictive value. Loading conditions and ventriculo-arterial coupling play important roles in RV function. The current treatment approach to RV failure includes a combination of inotropy and vasodilatation but lacks conclusive evidence. Emerging biochemical and molecular targets hold promise but have yet to be proven in human studies.
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Vader JM, Cooper DH, Rao P. Re-Thinking Re-Synching in Left Ventricular Assist Device Recipients. J Am Heart Assoc 2018; 7:e009591. [PMID: 29907653 PMCID: PMC6220548 DOI: 10.1161/jaha.118.009591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Praveen Rao
- Baylor University Medical Center, Dallas, TX
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Sharma A, Lavie CJ, Vallakati A, Garg A, Goel S, Lazar J, Fonarow GC. Changes in parameters of right ventricular function with cardiac resynchronization therapy. Clin Cardiol 2017; 40:1033-1043. [PMID: 28898433 DOI: 10.1002/clc.22762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/09/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Studies have shown that cardiac resynchronization therapy (CRT) significantly improves right ventricle (RV) size and function in patients with heart failure (HF). HYPOTHESIS CRT does not lead to improvement in RV function independent of baseline clinical variables. METHODS A systematic search of studies published between 1966 to August 31, 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies reporting tricuspid annular plane systolic excursion (TAPSE) or RV basal strain or RV long axis diameter or RV short axis diameter or RV fractional area change (FAC), before and after CRT, were identified. A meta-analysis was performed using random effects with inverse variance method to determine the pooled mean difference in various parameters of RV function after CRT. Meta-regression analysis was performed to test the relationship between change in various parameters of RV functions after CRT and covariates- age, QRS duration, and left ventricular ejection fraction (LVEF). RESULTS Thirteen studies (N=1541) were selected for final analysis. CRT therapy led to statistically significant increases in TAPSE [1.21 (95% CI 0.55-1.86; p<0.001)], RV FAC [2.26 (95% CI 0.50-4.01; p<0.001)] and basal strain [2.82 (95% CI 0.59-5.05; p<0.001)] and statistically significant decreases in mean RV long axis diameter [-2.94 (95% CI -5.07- -0.82; p=0.005)] and short axis diameter [-1.39 (95% CI -2.10- -0.67; p=0.876)] after a mean follow up period of 9 months. However, after meta-regression analysis for age, QRS duration, and baseline LVEF as covariates, there was no significant improvement in any of the parameters of RV function after CRT. CONCLUSION There was a statistically significant improvement in TAPSE, RV basal strain, RV fractional area, RV long axis and short axis with CRT. However, improvement in these echocardiographic parameters of RV function after CRT was not independent of baseline clinical variables but statistically dependent on age, QRS duration and baseline LVEF.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York.,Institute of Cardiovascular Research and Technology, Brooklyn, New York
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana
| | - Ajay Vallakati
- Division of Cardiovascular Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Akash Garg
- Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Sunny Goel
- Department of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Jason Lazar
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Gregg C Fonarow
- Division of Cardiology, University of California, Los Angeles, California
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