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Interplay between right ventricular function and cardiac resynchronization therapy : an analysis of the CARE-HF trial (cardiac resynchronization–heart failure)

Damy, Thibaud; Ghio, Stefano; Rigby, Alan S.; Hittinger, Luc; Jacobs, Sandra; Leyva, Francisco; Delgado, Juan F.; Daubert, Jean-Claude; Gras, Daniel; Tavazzi, Luigi; Cleland, John G.F.

Authors

Thibaud Damy

Stefano Ghio

Luc Hittinger

Sandra Jacobs

Francisco Leyva

Juan F. Delgado

Jean-Claude Daubert

Daniel Gras

Luigi Tavazzi

John G.F. Cleland



Abstract

Objectives: The aim of this study was to investigate the impact of cardiac resynchronization therapy (CRT) on right ventricular (RV) function and the influence of RV dysfunction on the echocardiographic and clinical response to CRT among patients enrolled in the CARE-HF (Cardiac Resynchronization-Heart Failure) trial. Background: Cardiac resynchronization therapy prolongs survival in appropriately selected patients with heart failure but the benefit might be diminished in patients with RV dysfunction. Methods: Of 813 patients enrolled in the CARE-HF study, 688 had tricuspid plane systolic excursion (TAPSE) measured at baseline, and 345 of these were assigned to CRT. Their median (interquartile range) age was 66 (58 to 71) years, left ventricular (LV) ejection fraction was 24% (21% to 28%), and TAPSE was 19 (16 to 22) mm. Baseline LV function and size and QRS duration were similar among TAPSE tertiles, but those in the worst tertile (TAPSE < 17.4 mm) were more likely to have ischemic heart disease. Results: Overall, CRT improved LV but not RV structure and function with little evidence of an interaction with TAPSE. During a median (interquartile range) follow-up of 748 (582 to 950) days, 213 deaths occurred. Patients with lower TAPSE had a higher mortality, regardless of assigned treatment (p < 0.001). Greater inter-ventricular mechanical delay, New York Heart Association functional class, mitral regurgitation, and N-terminal pro-B-type natriuretic peptide, lower TAPSE, and assignment to the control group were independently associated with higher mortality. Reduction in mortality with CRT was similar in each tertile of TAPSE. Conclusions: Right ventricular dysfunction is a powerful determinant of prognosis among candidates for CRT, regardless of treatment assigned, but did not diminish the prognostic benefits of CRT among patients enrolled in the CARE-HF trial. (Care-HF CArdiac Resynchronization in Heart Failure; NCT00170300) © 2013 American College of Cardiology Foundation.

Citation

Damy, T., Ghio, S., Rigby, A. S., Hittinger, L., Jacobs, S., Leyva, F., …Cleland, J. G. (2013). Interplay between right ventricular function and cardiac resynchronization therapy : an analysis of the CARE-HF trial (cardiac resynchronization–heart failure). Journal of the American College of Cardiology, 61(21), 2153-2160. https://doi.org/10.1016/j.jacc.2013.02.049

Acceptance Date Feb 17, 2013
Online Publication Date Mar 26, 2013
Publication Date May 28, 2013
Deposit Date Nov 13, 2014
Publicly Available Date Nov 13, 2014
Journal Journal of the American College of Cardiology
Print ISSN 0735-1097
Electronic ISSN 1558-3597
Publisher Elsevier
Peer Reviewed Not Peer Reviewed
Volume 61
Issue 21
Pages 2153-2160
DOI https://doi.org/10.1016/j.jacc.2013.02.049
Keywords Cardiology and Cardiovascular Medicine
Public URL https://hull-repository.worktribe.com/output/469931
Publisher URL http://www.sciencedirect.com/science/article/pii/S0735109713012047
Additional Information Authors' accepted manuscript of article published in: Journal of the American College of Cardiology, 2013, v.2013, v.21, issue 21

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