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.