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Interplay Between Right Ventricular Function and Cardiac Resynchronisation Therapy: An Analysis of the CARE-HF Trial
Study Questions:
What is the role of cardiac resynchronization therapy (CRT) in patients with right ventricular (RV) dysfunction, and how does RV dysfunction impact the clinical response to CRT?
Methods:
This study was based on 688 patients of the 813 patients who were analyzed from the CARE-HF (Cardiac Resynchronization-Heart Failure) trial. These patients had lateral wall tricuspid annular plane systolic excursion (TAPSE) measured by M-mode at baseline, 3, 9, and 18 months. Of these patients, 345 patients were assigned to CRT.
Results:
The median age (interquartile range) was 66 (58-71) years, left ventricular (LV) ejection fraction was 24 (21-28%), and TAPSE was 19 (16-22) mm. Median follow-up was 748 (58-950) days, and 213 deaths occurred. Patients with the lowest TAPSE (≤1 mm4) were more often men, and more likely to have ischemic heart disease and to have evidence of more severe heart failure. CRT was found to improve LV, but not RV structure and function, and patients with lower TAPSE had higher mortality regardless of treatment assigned (p < 0.001). However, the benefit of CRT on outcomes was similar across tertiles of TAPSE.
Conclusions:
CRT has a minimal effect on RV function and the severity of RV dysfunction is a weak determinant of the benefits of CRT. RV dysfunction does not inhibit the benefits of CRT therapy in those patients who were enrolled in the CARE-HF trial.
Perspective:
This is the first randomized controlled study to assess the effect of CRT on RV function. CRT may be expected to improve RV structure by altering hemodynamics; however, in this study, there appears to be no significant improvement in right heart function, which ultimately did not prevent the prognostic effects of CRT.
Keywords: Prognosis, Coronary Artery Disease, Myocardial Ischemia, Follow-Up Studies, Cardiac Pacing, Artificial, Ventricular Function, Left, Heart Failure, Hemodynamics, Ventricular Dysfunction, Right, Cardiac Resynchronization Therapy
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