CMR-derived measures of right ventricular function, such as RVEF, were not independently associated with long-term clinical outcomes after cardiac resynchronization therapy.
Cohort (n=243)
Does pre-implant right ventricular function assessed by CMR predict long-term clinical outcomes in patients receiving cardiac resynchronization therapy?
Pre-implant right ventricular function assessed by CMR does not independently predict long-term clinical outcomes after CRT and should not be used for patient selection.
Hazard Ratio: 0.82 (95% CI 0.7–0.96)
BACKGROUND: Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT. METHODS: In this retrospective study, we used CMR to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation. RESULTS: Among 243 patients (age: 70.3 ± 10.8 years mean ± SD; 68.7% male; 121 49.8%) with ischemic cardiomyopathy and 122 (50.2%) with nonischemic cardiomyopathy, 141 (58%) after CRT-defibrillation (CRT-D) and 102 (42%) after CRT-pacing (CRT-P), 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from noncardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and four (1.64%) had a left ventricular assist device (LVAD). A total of 41 (16.9%) met the composite endpoint of sudden cardiac death (SCD), ventricular tachycardia, or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction. CONCLUSIONS: There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection.
Zegard et al. (Thu,) conducted a cohort in Ischemic and nonischemic cardiomyopathy after cardiac resynchronization therapy (n=243). CMR-derived measures of right ventricular function (RVEF and RV volumes) was evaluated on Cardiac mortality (HR 0.82, 95% CI 0.70-0.96). CMR-derived measures of right ventricular function, such as RVEF, were not independently associated with long-term clinical outcomes after cardiac resynchronization therapy.
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