125 Left Ventricular Systolic Mechanics is not the only determinant of response to Cardiac resynchronization Therapy

Abstract

Diastolic left ventricular (LV) and right ventricular (RV) function are major determinants of outcome in chronic heart failure (CHF) patients. Cardiac resynchronization therapy (CRT) is a major therapy for severe symptomatic CHF-patients. But the way diastolic and RV-functions influence response to CRT remains unknown. Prospective evaluation of RV and LV-diastolic functions on LV-remodeling after 6-month of CRT according to current guidelines. 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-months of CRT. RV-function was assessed by tricuspid annulus plane systolic velocity (Vs RV) with a cut-off of 11.5 cm/s. Diastolic LV function was assessed owing to E/A, mean E/e’ (septal and lateral annulus) and left atrial volume (LAV (ml/m2)). Reverse remodelling was defined as reduction in LV end-systolic volume ≥ 15%. Eighteen patients had RV dysfunction (mean Vs RV=7.6 ±1.2cm/s) and 20 had normal RV function (13.6±2.7cm/s). Ejection fraction and LV volumes were not different according to RV-function. Patients with RV-dysfunction had more advanced diastolic dysfunction (mitral inflow E/A=2.2±1.7 vs. 1.2±0.8, p=0.02; E/e’=22.7±7.8 vs. 14.4±4, p<0.01) and largest LAV indexed (63.7±23.9ml/m2 vs. 41.7±13.6 ml/m2, p<0.01). Vs RV was significantly correlated with parameters of LV diastole (fig1). RV dysfunction was associated and correlated with a weak LV-reverse remodelling at 6-month follow-up (75% vs. 44%, p<0.05 and R = 0.46, p<0.05 between delta (pre/6-month post) of LV end systolic volume and Vs RV). RV-dysfunction and LV diastolic characteristics were correlated. Worse was RV function worse was LV-reverse remodelling. RV function and degree of diastolic dysfunction should probably be taking into account when considering patients for CRT.Download : Download full-size image