Background . Although cardiac resynchronization therapy (CRT) has been demonstrated to result in a sustained improvement in symptoms and left ventricular (LV) systolic function in patients with advanced heart failure, very few data are available regarding the effects of CRT on right ventricular (RV) function. The purpose of our study was to analyse the evolution of LV as well as RV tissue Doppler / strain Doppler imaging (TDI/SRI) parameters after CRT. Methods. Fifty-six patients with dilated cardiomyopathy (NYHA class II or greater), left bundle branch block (QRS >120ms), and LV ejection fraction <35% were studied with TDI/SRI echocardiography before and after CRT. Intraventricular dyssynchrony was determined as the difference between the longest and shortest electromechanical coupling times in the basal septal, lateral, and posterior LV segments. Interventricular dyssynchrony was determined as the difference between electromechanical coupling times in the basal lateral RV segment and the most delayed LV segment. Velocity and strain traces from RV free wall were processed in the apical 4-chamber view. Systolic (Sw) and diastolic (Ew, Aw) TDI values, peak systolic strain and systolic and diastolic strain rate values were determined. Results. At six months follow-up after CRT, patients functional status improved by one NYHA class or more and LVEF improved overall from 19.7 ± 6.9% to 28.8 ± 10.9%. A significant reduction in severity of tricuspid regurgitation and pulmonary artery pressure was also observed. Interventricular dyssynchrony by SRI was reduced from 81.3 ± 28 ms to 35.8 ± 21.5 ms (p<0.005) and intraventricular dyssynchrony from 78 ± 30.6 ms to 24.1 ± 14.8 ms (p<0.001). The degree of dyssynchrony correlated significantly with the improvement in LVEF and LV end-diastolic diameter. An increase of Ew at basal RV level from -11.6 ± 1.8 cm/s to -16.1 ± 1.4 cm/s was shown (p<0.005). Peak systolic strain and systolic and early diastolic strain rate at basal RV level increased, respectively, from 21.2 ± 6.3% to 30.7 ± 6.9%, -2.9 ± 1.7 cm/s to -4.8 ± 1.2 sec-1, and 5.1 ± 1.6 cm/s to 8.1 ± 1.2 sec-1 (p<0.001). RV reverse remodeling was only observed in patients with highest degrees of LV dyssynchrony at baseline. Conclusions. Our data show that CRT not only induced LV reverse remodeling, but also resulted in a significant increase of RV deformation parameters. RV reverse remodeling was associated with a reduction in the severity of tricuspid regurgitation and a significant decrease in pulmonary artery pressure.
Right ventricular function after cardiac resynchronization therapy: A strain Doppler imaging study / Vitarelli, Antonino; Franciosa, P; Conde, Y; Cimino, E; Dorazio, S; Stellato, S; Battaglia, Daniela; Padella, V; CORTES MORICHETTI, M; Rosanio, S.. - In: EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY. - ISSN 1525-2167. - STAMPA. - (2007), p. P1126. (Intervento presentato al convegno Euroecho 11 tenutosi a Lisbon, Portugal nel 5-8 Dec. 2007).
Right ventricular function after cardiac resynchronization therapy: A strain Doppler imaging study
VITARELLI, Antonino;BATTAGLIA, DANIELA;
2007
Abstract
Background . Although cardiac resynchronization therapy (CRT) has been demonstrated to result in a sustained improvement in symptoms and left ventricular (LV) systolic function in patients with advanced heart failure, very few data are available regarding the effects of CRT on right ventricular (RV) function. The purpose of our study was to analyse the evolution of LV as well as RV tissue Doppler / strain Doppler imaging (TDI/SRI) parameters after CRT. Methods. Fifty-six patients with dilated cardiomyopathy (NYHA class II or greater), left bundle branch block (QRS >120ms), and LV ejection fraction <35% were studied with TDI/SRI echocardiography before and after CRT. Intraventricular dyssynchrony was determined as the difference between the longest and shortest electromechanical coupling times in the basal septal, lateral, and posterior LV segments. Interventricular dyssynchrony was determined as the difference between electromechanical coupling times in the basal lateral RV segment and the most delayed LV segment. Velocity and strain traces from RV free wall were processed in the apical 4-chamber view. Systolic (Sw) and diastolic (Ew, Aw) TDI values, peak systolic strain and systolic and diastolic strain rate values were determined. Results. At six months follow-up after CRT, patients functional status improved by one NYHA class or more and LVEF improved overall from 19.7 ± 6.9% to 28.8 ± 10.9%. A significant reduction in severity of tricuspid regurgitation and pulmonary artery pressure was also observed. Interventricular dyssynchrony by SRI was reduced from 81.3 ± 28 ms to 35.8 ± 21.5 ms (p<0.005) and intraventricular dyssynchrony from 78 ± 30.6 ms to 24.1 ± 14.8 ms (p<0.001). The degree of dyssynchrony correlated significantly with the improvement in LVEF and LV end-diastolic diameter. An increase of Ew at basal RV level from -11.6 ± 1.8 cm/s to -16.1 ± 1.4 cm/s was shown (p<0.005). Peak systolic strain and systolic and early diastolic strain rate at basal RV level increased, respectively, from 21.2 ± 6.3% to 30.7 ± 6.9%, -2.9 ± 1.7 cm/s to -4.8 ± 1.2 sec-1, and 5.1 ± 1.6 cm/s to 8.1 ± 1.2 sec-1 (p<0.001). RV reverse remodeling was only observed in patients with highest degrees of LV dyssynchrony at baseline. Conclusions. Our data show that CRT not only induced LV reverse remodeling, but also resulted in a significant increase of RV deformation parameters. RV reverse remodeling was associated with a reduction in the severity of tricuspid regurgitation and a significant decrease in pulmonary artery pressure.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
