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Baseline left ventricular d P /d t max rather than the acute improvement in d P /d t max predicts clinical outcome in patients with cardiac resynchronization therapy
Author(s) -
Bogaard Margot D.,
Houthuizen Patrick,
Bracke Frank A.,
Doevendans Pieter A.,
Prinzen Frits W.,
Meine Mathias,
Gelder Berry M.
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr094
Subject(s) - medicine , hazard ratio , cardiac resynchronization therapy , cardiology , heart failure , confidence interval , heart transplantation , hemodynamics , ejection fraction
Aims The maximum rate of left ventricular (LV) pressure rise (d P /d t max ) has been used to assess the acute haemodynamic effect of cardiac resynchronization therapy (CRT). We tested the hypothesis that LV d P /d t max predicts long‐term clinical outcome after initiation of CRT. Methods and results This was a retrospective observational multicentre study in 285 patients in whom d P /d t max was measured invasively following implantation of a CRT device. The minimum required follow‐up was 1 year. We analysed the relationship between d P /d t max and time to the composite endpoint, consisting of all‐cause mortality, heart transplantation (HTX), or LV assist device (LVAD) implantation within the first year of CRT. Thirty‐four events occurred after a mean follow‐up of 160 days (range 21–359). Patients with an event had lower d P /d t max than patients without an event both at baseline (705 ± 194 vs. 800 ± 222 mmHg/s, P = 0.018) and during CRT (894 ± 224 vs. 985 ± 244 mmHg/s, P = 0.033), but the acute increase in d P /d t max was similar in patients with and without an event (190 ± 133 vs. 185 ± 115 mmHg/s, P = n.s.). Left ventricular d P /d t max ‐level at baseline and during CRT both predicted the clinical outcome after adjustment for gender, aetiology and New York Heart Association class: hazard ratio (HR) 0.791 [95% confidence interval (CI) 0.658–0.950, P = 0.012] and HR 0.846 (95% CI 0.723–0.991, P = 0.038), respectively. Conclusion Left ventricular d P /d t max measured at baseline and during CRT are predictors of 1‐year survival free from all‐cause mortality, HTX, or LVAD implantation, but the acute improvement in d P /d t max is not correlated to clinical outcome.