Premium
Can Pulmonary Vascular Resistance Predict Response to Cardiac Resynchronization Therapy in Patients with Heart Failure?
Author(s) -
XU ZHOUTAO,
ZHANG HANG,
PAN CHANG,
ZHANG JUAN,
HU ZUOYING
Publication year - 2015
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/pace.12690
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , cardiology , vascular resistance , intensive care medicine , ejection fraction , hemodynamics
Background To evaluate if pulmonary vascular resistance (PVR) calculated by echocardiography can be a novel criterion to predict the response to cardiac resynchronization therapy (CRT). Methods Forty‐five patients with heart failure who underwent CRT were retrospectively analyzed. Based on CRT response, which was defined by a decrease of left ventricular end‐systolic volume by at least 15% after 6 months, the patients were assigned to the responder or nonresponder groups. The peak tricuspid regurgitant velocity (TRV) and time velocity integral of the right ventricular outflow tract (TVI RVOT ) were obtained. The relation between TRV, PVR, and CRT response were analyzed using univariate and multivariate analyses. Results Twenty‐seven patients (60%) were responders and 18 patients (40%) were nonresponders to CRT. At baseline, responders had lower PVR (3.57±1.65 vs 2.32 ± 1.28 wood; P = 0.01), or lower PVR 1 (3.26 ± 1.32 vs 1.83 ± 0.79 wood; P = 0.01) compared with nonresponders. Multivariate analysis has shown that PVR and PVR 1 were independent factors for CRT response. The optimal cutoff point of PVR to predict nonresponse to CRT was 2.39 wood, with a sensitivity of 0.78 and a specificity of 0.81 (95% confidence interval [CI]: 53.4–88.2). The optimal cutoff point of PVR 1 calculated by the other model was 3.55 wood, determined at a sensitivity of 0.72 and a specificity of 0.82 (95%CI: 56.7–90.7). In nonresponders, patients demonstrated higher PVR, TVI A , and TVI RVOT , and decreased TRV. Conclusions PVR could be used to predict response to CRT after 6 months as a novel criterion, and higher PVR may indicate nonresponse.