B-PO05-182 IS THERE A POINT IN EVALUATING RIGHT VENTRICULAR GLOBAL LONGITUDINAL STRAIN PRIOR TO CARDIAC RESYNCHRONIZATION THERAPY?

Abstract

Cardiac resynchronization therapy (CRT) is a well proven treatment for heart failure patients with reduced ejection fraction (HFrEF). There is a strong need to find new factors that predict and/or influence the response to CRT. Most previous studies have focused mainly on the left ventricle (LV). The role of the right ventricle (RV) in CRT patients is uncertain. We sought to analyze the value of right ventricle global longitudinal strain (RVGLS) evaluation prior to CRT. Our study included patients with HFrEF undergoing CRT. RVGLS was measured using two-dimensional images acquired from the four-chamber view for offline analysis using the strain software (EchoPAC, General Electric Vingmed Ultrasound). RVGLS was calculated by the average of 6 segmental values of the lateral wall and interventricular septum. We used the absolute value of RVGLS, measured prior to CRT and twelve months after implantation. The study population consisted of fifty-four patients with a mean age 64.0 ± 13.8 years, 55% male gender, 29% ischemic etiology of HFrEF. A baseline lower RVLGS was associated with more adverse cardiovascular events (HF hospitalizations and death) during follow up (r=-0.46, p=0.007) and a higher NYHA class at baseline (r=-0.49, p =0.003). RVGLS value varied significantly among NYHA classes (F (54,2) = 5, p =0.01). A lower baseline RVGLS was associated with a lower LVEF (r=0.47, p =0.004) and a more dilated LV (r=-0.46, p =0.004). A low RVGLS was also correlated with higher estimated pulmonary systolic pressure (p<0.001). Baseline RVGLS was significantly lower in patients without echocardiographic response to CRT compared to responders (p<0.001). RVGLS proved to be a good predictor for response to CRT with a good ability to discriminate between responders and non-responders (AUC = 0.85, 95% CI, 0.70-1). We propose a cut off value for RVGLS = - 12 (sensibility 73%, specificity 80%). Evaluation of RVGLS provides valuable prognostic information in HF patients undergoing CRT. A lower baseline RVGLS predicts lack of response to CRT and was associated with more adverse cardiovascular events during follow up. Measurement of RVGLS may be useful in the evaluation of HFrEF patients prior to CRT, pending validation in larger studies.