Right ventricular function, pulmonary pressure estimation, and clinical outcomes in cardiac resynchronization therapy

Patricia Campbell, Madoka Takeuchi, Mikhail Bourgoun, Amil Shah, Elyse Foster, Mary W. Brown, Ilan Goldenberg, David T. Huang, Scott McNitt, W. Jackson Hall, Arthur Moss, Marc A. Pfeffer, Scott D. Solomon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background-Right ventricular function (RVF) is an important determinant of outcome in patients with heart failure, and those with severe RV dysfunction have worse outcome after cardiac resynchronization therapy (CRT). We used data from the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) Trial to determine whether therapy with CRT is influenced by or affects RV function and to define the relationship between RV function and outcomes. Methods and Results-A total of 1820 patients were randomly assigned to CRT plus implantable cardioverter defibrillator or implantable cardioverter defibrillator-only in a 3:2 ratio. We assessed RVF as RV fractional area change by echocardiography at baseline and after 1 year of therapy (n=1511 and 1273, respectively). The median RV fractional area change was 41%, with 10.9% of patients <35% at baseline. Baseline RVF did not modify the treatment effect of CRT on the primary outcome (interaction P=0.19). Randomization to CRT-implantable cardioverter defibrillator was associated with a greater improvement in RVF (δRV fractional area change 8.1% versus 5.4%; P<0.001), and improvement in RVF was related to subsequent outcomes. Every 5-point increase in RV fractional area change was associated with a 22% reduction in event rates (hazard ratio, 0.78; 95% confidence interval, 0.66-0.92; P=0.003), although this was not independent of the concurrent improvement in left ventricular function. Baseline tricuspid regurgitant velocity, a measure of pulmonary systolic pressure, was predictive of events in a multivariate analysis (hazard ratio, 1.86; 95% confidence interval, 1.24-2.8; P=0.003). Conclusions-In this population with mild heart failure symptoms, CRT was associated with improvement in RVF, which improved in parallel with improvement in left ventricular function. Patients with the best RVF at 1 year demonstrated the lowest subsequent event rates.

Original languageEnglish
Pages (from-to)435-442
Number of pages8
JournalCirculation: Heart Failure
Volume6
Issue number3
DOIs
StatePublished - May 2013
Externally publishedYes

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Right ventricle

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