Right Ventricular Longitudinal Strain And Combined Left And Right Ventricular Longitudinal Strain Parameter Are Predictors Of Reverse Remodeling After Cardiac Resynchronization Therapy

OBJECTIVESTo identify the strain echocardiographic parameters for predicting LV reverse remodeling after Cardiac Resynchronization Therapy.METHODSPart One:60 consecutive patients with heart failure for implantation of a biventricular pacemaker at PLA General Hospital between January 1st 2005 to December 31st 2013 were enrolled 。 Echocardiographic and clinical data were collected at baseline and six months after implantation, including right ventricular longitudinal strain(RVLS). Patients are grouped according to echocardiographic response. Multivariable analysis was performed on parameters that were significant on the univariate analysis. The sensitivity and specificity of the best performing cutoff value for the parameters was determined using receiver operating characteristic curve analysis.Part Two:50 consecutive patients with heart failure for implantation of a biventricular pacemaker were enrolled. Echocardiographic and clinical data were collected at baseline and six months after implantation, including left ventricular longitudinal strain(LVLS), right ventricular longitudinal strain(RVLS). Patients are grouped according to echocardiographic response. Multivariable analysis was performed on parameters that were significant on the univariate analysis. The sensitivity and specificity of the best performing cutoff value for the parameters was determined using receiver operating characteristic curve analysis. These echocardiographic parameters were combined to predict LV reverse remodeling after CRT.RESULTSPart One:Of 60 consecutive patients,38 patients were CRT responders (63%) and 22 were non-responders(37%). Echocardiographic indexes of baseline right ventricular longitudinal strain(RVLS) were significantly more impaired in nonresponders versus responders to CRT(p<0.001). Multiple logistic analysis identified RVLS [OR3.55 CI(2.34-5.47) p<0.001]as the independent predictor of reverse remodeling after Cardiac Resynchronization Therapy. The cut off values were defined as RVLS>17% with the highest sensitivity (78.8%) and specificity (62.3%).Part Two: ① Echocardiographic indexes of baseline left ventricular longitudinal strain(LVLS), right ventricular longitudinal strain(RVLS) were significantly more impaired in nonresponders versus responders to CRT(p<0.001).Multiple logistic analysis identified LVLS [OR3.45 CI(2.47-10.86),P<0.01], RVLS [OR 3.01 CI(1.98-4.66)P<0.01]as the independent predictor of reverse remodeling after Cardiac Resynchronization Therapy. ② The cut off values were defined as LVLS>9.7% with 90% sensitivity、42% specificity and 72% accuracy, (AUC=0.22, P<0.01)and RVSLS>16.8% with 87% sensitivity 53% specificity and 74% accuracy (AUC=0.703, P< 0.01). Patients with baseline LVLS>9.7% and RVLS>16.8% named Both-responder. Others named No Both-responder. Combined LVLS and RVLS predicted CRT response with 84% sensitivity、68% specificity and 78% accuracy, which was significantly better than either technique alone (AUC=0.798,P<0.01)CONCLUTION1. RV function assessed by velocity vector imaging, appears to be an independent predictor of LV reverse remodeling after CRT.2.Left and right ventricular systolic function are associated with LV reverse remodeling after Cardiac Resynchronization Therapy..The combined echocardiographic parameters of left and right ventricular longitudinal strain predicts the outcomes more accurately than single echocardiographic parameter.