Cardiac resynchronization therapy was associated with a greater improvement in right ventricular fractional area change compared to ICD-only (8.1% vs 5.4%; P<0.001).
RCT (n=1,820)
3:2 ratio
Yes
Does CRT plus ICD improve right ventricular function and reduce event rates compared to ICD alone in patients with mild heart failure?
In patients with mild heart failure, CRT improves right ventricular function in parallel with left ventricular function, and better RV function at 1 year is associated with lower subsequent event rates.
Absolute Event Rate: 8.1% vs 5.4%
p-value: p=<0.001
BACKGROUND: Right ventricular function (RVF) is an important determinant of outcome in patients with heart failure, and those with severe RV dysfunction have worse outcome after cardiac resynchronization therapy (CRT). We used data from the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) Trial to determine whether therapy with CRT is influenced by or affects RV function and to define the relationship between RV function and outcomes. METHODS AND RESULTS: A total of 1820 patients were randomly assigned to CRT plus implantable cardioverter defibrillator or implantable cardioverter defibrillator-only in a 3:2 ratio. We assessed RVF as RV fractional area change by echocardiography at baseline and after 1 year of therapy (n=1511 and 1273, respectively). The median RV fractional area change was 41%, with 10.9% of patients <35% at baseline. Baseline RVF did not modify the treatment effect of CRT on the primary outcome (interaction P=0.19). Randomization to CRT-implantable cardioverter defibrillator was associated with a greater improvement in RVF (ΔRV fractional area change 8.1% versus 5.4%; P<0.001), and improvement in RVF was related to subsequent outcomes. Every 5-point increase in RV fractional area change was associated with a 22% reduction in event rates (hazard ratio, 0.78; 95% confidence interval, 0.66-0.92; P=0.003), although this was not independent of the concurrent improvement in left ventricular function. Baseline tricuspid regurgitant velocity, a measure of pulmonary systolic pressure, was predictive of events in a multivariate analysis (hazard ratio, 1.86; 95% confidence interval, 1.24-2.8; P=0.003). CONCLUSIONS: In this population with mild heart failure symptoms, CRT was associated with improvement in RVF, which improved in parallel with improvement in left ventricular function. Patients with the best RVF at 1 year demonstrated the lowest subsequent event rates. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01294449.
Campbell et al. (Sat,) conducted a rct in mild heart failure symptoms (n=1,820). CRT plus implantable cardioverter defibrillator vs. implantable cardioverter defibrillator-only was evaluated on improvement in RVF (ΔRV fractional area change) (p=<0.001). Cardiac resynchronization therapy was associated with a greater improvement in right ventricular fractional area change compared to ICD-only (8.1% vs 5.4%; P<0.001).
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