Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cappelli, Francesco; Porciani, Maria Cristina; Ricceri, Ilaria; Perrotta, Laura; Ricciardi, Giuseppe; Pieragnoli, Paolo; Paladini, Giulia; Michelucci, Antonio; Padeletti, Luigi

doi:10.1002/clc.20806

Cited by 28 publications

(21 citation statements)

References 22 publications

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“…Our results are in agreement with Capelli et al, 36 who demonstrated that CRT induces both RV and LV reverse remodeling, and is more effective in patients with higher TAPSE. In addition, Scuteri et al 32 concluded that low baseline TAPSE was associated with poor response and adverse prognosis, while Sade et al 37 showed that preserved RV function is an independent predictor of long-term event-free survival after CRT.…”

Section: Discussionsupporting

confidence: 93%

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Abreu

Oliveira

Cunha

et al. 2017

Revista Portuguesa de Cardiologia

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Introduction: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims: To identify baseline characteristics that might influence echocardiographic response to CRT. Methods and Results:We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%).At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. * Corresponding author. E-mail address: ananabreu@hotmail.com (A. Abreu). 2174-2049Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 21/07/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 418 A. Abreu et al. Conclusion: From a range of clinical and technical baseline characteristics, Metodologia e resultados:Estudo cohort prospetivo, unicêntrico, hospitalar, de doentes consecutivos com HF selecionados para CRT (classes II-IV NYHA, fração de ejeção ventricular esquerda <35% e QRS≥120 mseg).Os respondedores foram definidos por aumento absoluto de fração de ejeção ventricular esquerda ≥5% aos 6 meses.Antes da implantação do ressincronizador, foram avaliados parâmetros clínicos, eletrocardiográficos, laboratoriais, ecocardiográficos, autonómicos, endoteliais e funcionais cardiorrespiratórios. Utilizaram-se modelos de regressão logística.Incluíram-se 79 doentes, 54 masculinos (68,4%), idade 68,1 (SD=10,2) anos, 19 isquémicos (24%). Aos 6 meses, consideraram-se respondedores 51 doentes (64,6%). Apesar de, por análise univariável, a excursão sistólica do plano do anel tricúspide (TAPSE) e a creatinina sérica serem significativamente diferentes nos respondedores, em análise multivariável, apenas TAPSE foi independentemente associada a res...

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Section: Discussionsupporting

confidence: 93%

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Abreu

Oliveira

Cunha

et al. 2017

Revista Portuguesa de Cardiologia

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“…These results match Damy et alCARE-HF (Cardiac Resynchronization-Heart Failure) trial which found that,Right ventricular dysfunction is a powerful determinant of prognosis among candidates for CRT, and also concluded that patients with lower TAPSE at baseline had a higher mortality, regardless of assigned treatment (P = 0.001).16 it also matches Cappelli et al who had shown relatively similar results their study. They found after a follow up of 6 months that TAPSE, at 17 mm is an optimal cut-off, yielded 64% sensitivity and 60% specificity in predicting CRT response (17) . Also Schmeisser et al used baseline RV-PA coupling (RV function related to pulmonary vascular afterload) and PA compliance and found it an independent predictors of left ventricular reverse remodeling after CRT (18) .…”

Section: Rv Reverse Remodelingmentioning

confidence: 99%

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2017

IAM

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Background: Cardiac resynchronization therapy (CRT) is an established treatment of heart failure with reduced EF (HFrEF) and wide QRS complex. Nearly 30% of candidates are non-responders. One of the suggested mechanisms of inadequate response is the reduced baseline RV function; also the effect of CRT on right ventricular systolic function has not been well studied. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response. Methods: 30 patients with a mean age of 51.9 ± 9.2 years including 9 (30%) females, with advanced HF (EF < 35%, LBBB > 120 ms, or non-LBBB > 150 ms, with NYHA class III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD1 basal), maximum mid (RVD2 mid) transverse, maximum longitudinal (RVD3 long) diameters, TAPSE, fractional area change (FAC), right ventricle index of myocardial performance(RIMP) and tricuspid lateral annular systolic velocity (S'), were done before CRT implantation and at the end of the follow up period (6 months). Patients presenting with reduction of LVESV of >15% were considered responders. Results: 20 (67%) cases were responders. Both groups were similar regarding demographic, clinical, ECG, and echocardiographic criteria at baseline however, the RA volume and RV transverse diameters were smaller and systolic function parameters were significantly better in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters together with significant improvement in RV systolic function, in contrast to non-responders group who showed more RV dilatation and more decline of RV systolic function, compared to baseline readings(with P value <0.0001 for all parameters), Correlation between RV parameters before CRT implantation and CRT response was performed and ROC curves were plotted to define cutoff values for each parameter with FAC of >40 % has 85% sensitivity and 90 % specificity (P value= 0.004). TAPSE of >20 mm has 85% sensitivity and 80 % specificity (P value=0.002), S' of >10 cm/s % has 85% sensitivity and 70 % specificity (P value=0.001) and RIMP of <0.52 has 85% sensitivity and 70 % specificity (P value=0.003) in predicting CRT response. Conclusions: CRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.

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“…A few studies looked at the relation of previous RV dysfunction with CRT effect on LV and RV remodeling [9,51,56], showing that a low baseline TAPSE could predict a bad response to CRT.…”

Section: Imaging Predictive Factorsmentioning

confidence: 99%

Imaging predictive factors and exercise training in CRT patients

Abreu

Santa-Clara

2016

Monaldi Arch Chest Dis

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Cardiac resynchronization therapy (CRT) is an established treatment for patients with moderate-to-severe chronic heart failure (CHF) and intraventricular conduction delay, which is identified by a QRS interval of 120 msec or more on a 12-lead electrocardiogram (ECG). CRT improves functional capacity, reduced hospitalizations for worsening CHF and increased survival, however, about 30-40% of patients who undergo CRT are non-responders with no clinical or echocardiographic improvement. Imaging parameters for prediction of CRT response have been reviewed. Cardiac magnetic resonance (CMR), recognized as the gold standard to assess viability, has shown to obtain good results regarding quantification of scar burden. CMR-derived measures of mechanical dyssynchrony appear to predict the outcome of CRT, however these have not been externally validated. Nuclear imaging techniques, namely single-photon emission cardiac tomography (SPECT) provide data on scar burden and location, left ventricular (LV) function, LV contraction and mechanical dyssynchrony from a single scan. The presence, location and burden of myocardial scar have been shown to affect response to CRT. However, compared to CMR, the low spatial resolution of scintigraphy might overestimate the scar extent. This problem can be overcome by positron emission tomography (PET). SPECT has also been used to quantify dyssynchrony, using phase analysis. Imaging investigation is ongoing, trying to better identify CRT non-responders. The combination of ExT in CRT has not been well investigated, however some data show that different aerobic exercise modes and intensities can further improve CRT benefits. Data available on the effects of ExT in patients with CRT have been reviewed.

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Tricuspid Annular Plane Systolic Excursion Evaluation Improves Selection of Cardiac Resynchronization Therapy Patients

Cited by 28 publications

References 22 publications

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

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Imaging predictive factors and exercise training in CRT patients

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