Baseline Right Ventricular Dysfunction Predicts Worse Outcomes in Patients Undergoing Cardiac Resynchronization Therapy Implantation.
J Card Fail
; 26(3): 227-232, 2020 Mar.
Article
em En
| MEDLINE
| ID: mdl-31881279
ABSTRACT
INTRODUCTION:
Cardiac resynchronization therapy (CRT) has been shown to improve survival in patients with systolic heart failure, wide QRS duration, and left-bundle-branch-block. However, CRT outcomes stratified by right ventricular (RV) function at implant have not been well studied.METHODS:
We retrospectively reviewed patients at Cleveland Clinic who underwent CRT implantation (n = 777) from 2003 to 2011 with a diagnosis of heart failure, echocardiography with both pre-CRT left ventricular ejection fraction (LVEF) ≤35% and available post-CRT echocardiography at 6 months post-implant. CRT response was defined as LVEF improvement ≥5%. Patients were separated into 2 groups normal or mild RV dysfunction (n = 570) labeled Normal RV; moderate to severe dysfunction (n = 207) labeled RV DYSFXN based on qualitative echocardiography assessment. Survival was calculated as time from CRT implant to death, left ventricular assist device implant, or heart transplant.RESULTS:
CRT response was significantly higher in patients with Normal RV (67%) compared with patients with RV DYSFXN (56%; Pâ¯=â¯.006). Kaplan-Meier analysis showed that CRT patients with Normal RV had significantly greater survival compared with patients with RV DYSFXN (P < .001). In multivariable Cox regression accounting for a priori covariates, RV DYSFXN was associated with worse survival (HR 1.41 [95% CI 1.14-1.75], Pâ¯=â¯.002) and lower CRT response (HR 0.66 [95% CI 0.44-0.97], Pâ¯=â¯.03).CONCLUSION:
Baseline RV dysfunction at CRT implant is an important predictor of worsened left ventricular remodeling and survival in CRT patients.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Disfunção Ventricular Direita
/
Terapia de Ressincronização Cardíaca
/
Insuficiência Cardíaca
Tipo de estudo:
Observational_studies
/
Prognostic_studies
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Qualitative_research
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Card Fail
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2020
Tipo de documento:
Article