Right ventricular systolic pressure predicts outcomes in patients with cardiac resynchronization therapy defibrillators.

BACKGROUND

Cardiac resynchronization therapy defibrillators (CRT-D) are a cornerstone of the treatment of heart failure and wide QRS. In such subjects, there is often concomitant right ventricular (RV) dysfunction.

AIMS

We aimed to assess whether there is an association between RV function parameters and all-cause mortality or CRT-D therapies.

METHODS

The clinical data from study participants were obtained from the COMMIT-HF registry (NCT02536443). RV function parameters we focused on were RV dimension, tricuspid annular plane systolic excursion, and right ventricular systolic pressure (RVSP). Data on the long-term hard endpoints were obtained from the national healthcare provider, while data on device therapies were obtained from the investigator-initiated remote monitoring database. The predictors of the study outcomes - all-cause mortality and appropriate and inappropriate CRT-D therapies - were assessed with multivariable logistic regression and Kaplan-Meier curves.

RESULTS

Between July 2009 and November 2019, 335 patients were enrolled in the remote monitoring program after implantation of CRT-D. During the median (IQR) follow-up of 5.3 (2.8-6.6) years, 117 of them (34.9%) died, 111 (33.1%) received appropriate and 37 (11.0%) inappropriate shocks. The independent predictors of all-cause mortality were reduced left ventricular ejection fraction and an increase in RVSP. Lower age and increased left ventricular end-diastolic diameter were independent predictors of appropriate therapies, while lower age and increased RVSP were independent predictors of inappropriate therapies. Neither tricuspid annular plane systolic excursion nor RV dimension was a predictor of the analyzed outcomes.

CONCLUSIONS

RVSP is an independent predictor of inappropriate therapies and all-cause mortality in remotely monitored patients with heart failure and CRT-D.