Assessment of Right Ventricular Function Before and after Cardiac Resynchronization Therapy

Abstract

C ardiac resynchronization therapy CRT is an established treatment of heart failure with reduced LVEF and wide QRS complex. It is well established that CRT improves LVEF in patients with heart failure. However, the systematic assessment of RV dimensions and function has not been uniformly carried out prior to CRT. This study aimed at studying the effect of CRT on RV dimensions and function assessed by echocardiography. Also to study the value of echocardiographic assessment of RV function prior to CRT in predicting response to CRT. This study included 30 patients with LVEF of <35% and QRS complex of ≥120 ms, with at least NYHA class 3 who did not respond to optimal medical therapy who underwent CRT implantation at Ain Shams university hospitals. Baseline echocardiography with systematic assessment of RV dimensions and function was done before and 3 months after CRT. The main age of the patients was 52.8 ±15.4. Our study included 24 males (80 %) and 6 females (20 %). Twelve patients (40%) had history of ischemic heart disease as the cause of HF; while 18 patients (60 %) were diagnosed as DCM. History taking included NYHA class and revealed that 24 patients (80%) had NYHA class III and 6 patients (20%) had ambulatory class IV. The effect of HF symptoms on daily activities during last 4 months was assessed using Minnesota HF questionnaire. Mean questionnaire score was 70.8 ± 15.1. Twelve leads ECG was recorded for all patients and analysis revealed that 23 patients had and ECG showing LBBB and 7 patients had non-LBBB morphology with a mean QRS duration 148.1 ± 10.1 msec.