Extent of RV remodeling prior to CRT may predict survival in patients with chronic HF
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More advanced right ventricular remodeling prior to cardiac resynchronization therapy for chronic HF was independently associated with reduced 5-year survival, researchers reported.
“Chronic left ventricular failure is the most frequent cause of right ventricular (RV) adverse remodeling, a complex process consisting of progressive RV dilatation and dysfunction,” Xavier Galloo, MD, of the department of cardiology at Leiden University Medical Center, the Netherlands, and colleagues wrote. “Both parameters individually, RV dilatation and RV dysfunction, are important prognostic markers in CRT recipients. However, the prognostic value of both parameters in a single model has not been evaluated.”
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To assess the prognostic value of RV remodeling in patients who underwent CRT, Galloo and colleagues utilized the departmental database to identify 773 patients (mean age, 66 years; 75% men) of the Leiden University Medical Center.
RV remodeling was assessed based on RV size measured by indexed RV end-diastolic area and RV function measured by tricuspid annular plane systolic excursion.
Participants were classified into four categories of RV remodeling prior to CRT implantation: normal RV size and function (34%); RV dilatation and normal RV function (13%); normal RV size and RV dysfunction (33%); RV dilatation and RV dysfunction (20%).
The primary endpoint was all-cause mortality.
The findings were published in a research letter in Circulation: Arrhythmia and Electrophysiology.
During a median follow-up of 94 months after CRT implantation, 62% of patients died.
Researchers observed that the cumulative 5-year survival after CRT implantation was worse in patients with more advanced RV remodeling (P < .001):
- 83% of patients with normal RV size and function;
- 73% of patients with RV dilatation and normal RV function;
- 71% of patients with normal RV size and RV dysfunction; and
- 53% of patients with RV dilatation and RV dysfunction.
Using multivariable Cox regression analysis, researchers reported that RV size and RV function were independently associated with all-cause mortality, both individually and in combination, according to the study.
Moreover, evaluation of both RV size and function provided incremental prognostic value over either value individually (P for change in likelihood-ration test < .05).
“The extent of RV remodeling prior to CRT implantation is strongly associated with worse survival. Furthermore, RV size and RV function were, both individually and in combination, independently associated with all-cause mortality,” the researchers wrote. “This retrospective analysis included only CRT recipients, and therefore the relative benefit of CRT among heart failure patients with RV adverse remodeling cannot be evaluated. Nevertheless, the current study underscores that in patients who receive CRT the combination of RV size and RV function conferred incremental prognostic value to assess all-cause mortality over a broad range of recognized prognostic parameters, emphasizing that risk assessment of CRT recipients should systematically include comprehensive evaluation of RV size as well as RV function.”
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