Methods: The study population consisted of 67 severe HF pts with LBBB, on optimal medical treatment, who received CRTD, (10? and 57?), mean age 61±15 years, 33 with underlying disease ischemic cardiomyopathy and 34 with dilated cardiomyopathy. Most of them underwent optimization of CRT parameters at rest and on exercise. They underwent clinical evaluation and echocardiography assessment of LV dimensions, LVEF, MR quantification, RV dimensions, RVEF and tricuspid annular plane systolic excursion (TAPSE) before CRTD, after 6 months and long-term (6±2 years). Baseline FMR was present in 88% of pts (mild 20, moderate 30, severe 9 pts), severe RVD in 7pts (TAPSE<15mm).
Results: Forty-eight pts were CRT good clinical responders, 8 super responders and 11 pts poor responders. Twenty-three pts with moderate MR and 1 out of 9 pts with severe MR were good responders with early improvement of MR. Six pts (poor responders, severe FMR and severe RVD) died of pump failure. Two pts underwent surgical MR repair and 2 Percutaneous Mitral Clip with mild improvement of MR and HF. Severe baseline FMR and RVD TAPSE<15mm) were associated with hospital readmissions and poor survival (Kaplan-Meier analysis, p<0.001).
Conclusion: Severe baseline FMR and RVD are independent harbingers of resistant HF, unresponsive to CRT implementation and are associated with hospital readmissions and increased mortality and morbidity.