Improvement in right ventricular systolic function after cardiac resynchronization therapy correlates with left ventricular reverse remodeling |
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Authors: | Aksoy Hakan Okutucu Sercan Aytemir Kudret Kaya Ergun Baris Tulumen Erol Evranos Banu Fatihoglu Sefik Görkem Kabakci Giray Tokgozoglu Lale Ozkutlu Hilmi Oto Ali |
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Institution: | Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey. |
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Abstract: | Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function in heart failure (HF). However, the effects of CRT on right ventricular (RV) systolic function are not fully understood. Objective: We aimed to determine echocardiographic correlates of improvement in RV systolic function after CRT. Methods: Fifty‐four patients (61.9 ± 10.5 years; 43 men; LV ejection fraction 24.6 ± 4.0%; QRS duration > 120 ms) with HF were enrolled. Standard echocardiography, strain rate (SR), and tissue Doppler imaging were performed in all patients before and 6 months after CRT. Pulsed‐wave TDI‐derived systolic indices of RV included systolic (RVS) and isovolumic velocity (RVIVV) and isovolumic acceleration (RVIVA). Response to CRT was defined as decline in LV end‐systolic volume (LVESV) ≥ 10%. Results: When indices of RV systolic function were assessed between responders and nonresponders, in responders (38 patients, 70.4%) RV end‐diastolic diameters (RVD1–3), mid‐RV strain, and mid‐RV SR improved significantly (P < 0.01, for all). RVS (10.77 ± 4.29 vs 12.62 ± 4.10 cm/sec, P = 0.005), RVIVV (14.71 ± 5.88 vs 18.52 ± 6.62 cm/sec, P < 0.001), and RVIVA (1.69 ± 0.70 vs 2.39 ± 0.77 m/sec2, P < 0.001) significantly increased among responders. There was no significant change in these parameters among nonresponders. Pearson's analyses revealed moderate positive correlations between reduction of LVESV and ΔRVIVV (r = 0.467, P = 0.001) and ΔRVIVA (r = 0.473, P = 0.001), respectively. Conclusions: RV diameters and systolic indices after CRT improved only in the responder group. Improvement in RV systolic performance after CRT is correlated with the reduction of LVESV. (PACE 2011; 34:200–207) |
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Keywords: | cardiac resynchronization therapy echocardiography reverse remodeling right ventricular systolic function |
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