Purpose. The aim of the study was evaluation of standard parameters used for assessment of the RV in TTE: tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular systolic velocity (s’) and right ventricular fractional area change (RVFAC) and their potential correlation with NYHA functional class, NT-proBNP levels and 6-minute walk test (6-MWT) results in patients with HFrEF of ischemic origin, PAF, RV pacing and cardiac resynchronisation therapy (CRT).
Methods. Patients with PAF, HFrEF (NYHA II,III; LVEF =40%) and CIED, were enrolled in the study. Four groups were analysed: with sinus rhythm (control, group G1), with PAF (group G2), PAF and CRT for at least one year (group G3) and PAF and RV pacing (VVI mode) for at least 1 year (group G4). All the patients had TTE to assess the RV function: TAPSE, tricuspid lateral annular systolic velocity (s’) and RVFAC. 6-MWT and NT-proBNP were evaluated in all the patients. Spearman correlation coefficients were used to analyse data.
Results. Total of 126 patients were enrolled in the study: n=32 in group G1, n=28 in group G2, n=25 in group G3 and n=41 in group G4. The mean age of the patients was 70.5-74.5 years and mean heart rate: 75.5-79 per minute, with no significant differences between groups. Mean time of PAF duration was 3 years (G2), 5 years (G3), 5 years (G4). The mean LVEF was: 32.8% (G1), 30.4(G2), 27.8 (G3) and 26,4(G4). The mean RV diastolic area was: 21.0cm2(G1), 26.6cm2(G2), 23.5cm2 (G3), 24.5cm2 (G4), G1 vs. G2: p=0,0181. RV function parameters showed moderately depressed RV function in all studied groups. TAPSE and s‘ values correlated with functional NYHA class in all enrolled patients, respectively: TAPSE: 2.09±0.57cm, NYHA II; 1.78±0.47, NYHA III; p= 0.0038 and s’: 10.8±3.1cm/s, NYHA II; 9.2±2.4cm/s, NYHA III, p= 0.0323. That was not observed for RVFAC (38.6±12.6% in NYHA II; 35.6±12,2% in NYHA III; p=0.2133). Parameters of RV function did not correlate with NT-pro BNP levels and with 6-WMT results. Correlations between the RV function parameters and NT-proBNP and 6-MWT within the groups were not found.
Conclusions. HFrEF of ischemic origin in patients with permanent AF and CIED is a complex condition. RV function impairment correlated with NYHA functional class, but not with NT-proBNP and 6MWT results.