CRT improved right ventricular function in 36.5% of heart failure patients with RV dysfunction, linked to better LV remodeling, lower mortality, and fewer MACE events.
Does CRT-induced improvement in right ventricular function reduce major adverse cardiac events in heart failure patients with baseline right ventricular systolic dysfunction?
CRT improves right ventricular function in approximately one-third of heart failure patients with baseline RV dysfunction, which correlates with LV reverse remodeling and a significantly lower risk of major adverse cardiac events.
Abstract Introduction Cardiac resynchronization therapy (CRT) is an established treatment in heart failure (HF). However, the effect of CRT on the right ventricle (RV) function and potential reverse remodelling have not been well described. Purpose This study aimed to evaluate the impact of RV dysfunction and CRT-induced changes in RV function on clinical outcomes in HF patients (pts) treated with CRT. Methods Single-center retrospective study of consecutive pts submitted to CRT implantation (2017-2024). Echocardiographic parameters were evaluated at baseline and 6-12 months post-CRT. RV systolic dysfunction (RVSD) was defined as S’ velocity 9.5 cm/s or tricuspid annular plane systolic excursion (TAPSE) 17 mm. CRT response was defined as an increase of left ventricular ejection fraction (LVEF)≥10% or left ventricle end-systolic volume reduction (LVESV) ≥15%, and superresponse as LVEF≥50% at follow-up. Major adverse cardiac events (MACE) included HF hospitalization or cardiovascular mortality. Survival analysis with Kaplan-Meier method and Log-rank test was performed. Results A total of 206 pts (median age 74 IQR 66-79 years, 68,4% male, 67,5% non-ischemic cardiomyopathy) were included, 74 (35.9%) of whom had RVSD at baseline. Pts with RVSD were younger (70,5 vs 74.0 years, p=0.049), had higher alcohol consumption (42.5% vs 24.3%, p=0.01), higher prevalence of atrial fibrillation (45.9% vs 31.3%, p=0.042) and valvular prothesis (23.0% vs 3.7%, p0.001). They also had lower baseline LVEF (28.3% vs 31.2%, p=0.006) and were less likely to present left bundle branch block (44.6% vs 64.3%, p=0.008). RV function improved in 36.5% pts after CRT. Favorable RV response was more common in pts with significant baseline electromechanical intra-ventricular dyssynchrony (48.0% vs 19.4%, p=0.023). Pts with improved RV function exhibited better CRT response (83.3% vs 51.6%, p=0.014), a higher rate of superresponders (30.8% vs 9.4%, p=0.042), greater NYHA class improvement (84.6% vs 59.4%, p=0.036), and lower all-cause mortality (18.5% vs 42.4%, p=0,048). No differences were observed in HF medical therapy between groups. Over a mean follow-up of 35±24 months, patients with persistent RVSD had a higher occurrence of MACE events (38.8% vs 11.9%, log-rank p=0.003). Conclusion In this cohort, CRT was associated with RV function improvement in approximately one-third of HF patients with RVSD, which correlated with LV reverse remodelling and improved prognosis. Persistent RV dysfunction post-CRT was associated with higher occurrence of MACE events.
Moreira et al. (2025) studied this question. CRT improved right ventricular function in 36.5% of heart failure patients with RV dysfunction, linked to better LV remodeling, lower mortality, and fewer MACE events.