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Elevated Estimated Pulmonary Artery Systolic Pressure is Associated with an Adverse Clinical Outcome in Patients Receiving Cardiac Resynchronization Therapy
Author(s) -
STERN JOSHUA,
HEIST E. KEVIN,
MURRAY LORNE,
ALABIAD CHRISFOUAD,
CHUNG JEFFREY,
PICARD MICHAEL H.,
SEMIGRAN MARC J.,
RUSKIN JEREMY N.,
SINGH JAGMEET P.
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00719.x
Subject(s) - medicine , cardiology , ejection fraction , cardiac resynchronization therapy , pulmonary artery , heart failure , hazard ratio , qrs complex , blood pressure , clinical endpoint , population , clinical trial , confidence interval , environmental health
Background:A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV‐RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV‐RR after CRT.Methods:This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12‐month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP ≥ 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long‐term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan‐Meier method. Follow up echocardiograms to assess for LV‐RR were available in 51 subjects (mean duration 7.1 months). LV‐RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter.Results:The study population was composed of 24 women and 44 men (age, mean ± SD; 70 ± 11 years), with a decreased left ventricular ejection fraction ([25 ± 9]%) and a wide QRS (171 ± 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP ≥ 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2–5.5), P = 0.02). Baseline ePASP was not predictive of LV‐RR (P = 0.32).Conclusion:In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP ≥ 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long‐term outcome.