title: Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy.
abstract: 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 > or = 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 > or = 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).
  
  
  CONCLUSIONS
  In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP > or = 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long-term outcome.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Stern
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Lorne
authors.initials: L
authors.lastname: Murray
authors.forename: Chrisfouad
authors.initials: C
authors.lastname: Alabiad
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chung
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigran
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D016016:Proportional Hazards Models; D016896:Treatment Outcome