109 Left ventricular systolic function and Response to Cardiac Resynchronization Therapy is influenced by Right ventricular function as assessed by Echocardiography

Abstract

Right ventricular (RV) function has been proven to be a major determinant of clinical outcome in Chronic Heart Failure (CHF). The right and left (L) ventricles inter dependence has been weakly evaluated but might impact on response to treatments and prognosis. We sought to assess the impact of RV-function on LV-function by studying longitudinal and radial strains in CHF-patients selected for cardiac resynchronization therapy (CRT). Thirty-eight consecutive CHF-patients (New York Heart Association class III/IV, left ventricular ejection fraction [LVEF] less than 35%, QRS greater than 120 ms) were studied before and after 6-month of CRT. RV function was assessed by tricuspid annulus plane systolic velocity (Vs) with a cut-off of 11.5 cm/s. Global LV longitudinal strain (GLS) was measured (from the apical 4-chamber, apical 3-chamber and apical 2-chamber views) before and after CRT. Mean radial strain was measured from the parasternal mid-ventricular view. Reverse remodeling was defined by echocardiography at 6-month by a decrease in LV end-systolic volume ≥ 15%. Eighteen patients had RV-dysfunction (mean Vs=7.6 ±1.2cm/s) and 20 had normal RV-function (13.6±2.7cm/s). LVEF and volumes were non different between groups. Patients with RV-dysfunction had significantly worst global longitudinal strain before CRT (A-4Ch=-5.3±1.5% vs. -7.4±2.2%, p=0.01; A-2Ch=-5.7±1.2% vs. -9±2%, p<0.01; A-3Ch=-5±0.9% vs. -8.4±2.2%, p<0.01). After CRT, differences in global longitudinal strain were still significant. Considering mean radial strain, there were no differences between groups. The likelihood of response to CRT was significantly worse in patients having a RV dysfunction (75% vs. 44%, p<0.05). RV dysfunction diagnosed in patients planed for CRT is associated with a significantly worse LV global longitudinal function and a significantly weak likelihood of response to CRT at 6-month.