title: Elevated pulmonary artery pressure predicts poor outcome after cardiac resynchronization therapy.
abstract: OBJECTIVE
  Pulmonary artery hypertension is correlated with poor clinical prognosis in patients with chronic heart failure. However, there is a paucity of data concerning the impact of baseline pulmonary artery systolic pressure (PASP) on clinical outcome after cardiac resynchronization therapy (CRT). The aim of the study is to evaluate the association of baseline PASP with CRT response.
  
  
  METHODS
  One hundred eighty-seven consecutive patients undergoing CRT were screened for retrospective analysis. Patients were stratified into three groups based on preoperative PASP which was determined by echocardiogram (group I, PASP < 45 mmHg; group II, 45 mmHg ≤ PASP < 70 mmHg; and group III, PASP ≥ 70 mmHg). Clinical and echocardiographic improvements, as well as the response rate, were assessed 6 months after CRT. Long-term prognosis, measured as transplantation- and hospitalization-free survival, was also compared across the three groups.
  
  
  RESULTS
  One hundred eighty-three patients were evaluated with a mean age of 60.7 ± 11.2 years. At 6-month follow-up, patients in group I demonstrated greater clinical improvements (p < 0.05) and higher response rate (p < 0.01) than groups II and III. Compared with group I, death or transplantation was significantly more often noted in group II (hazard ratio, 4.89; 95% CI, 1.53-15.60; p = 0.007) and group III (hazard ratio, 5.91; 95% CI, 1.25-27.94; p = 0.025) as was heart failure readmission for group II (hazard ratio, 2.48; 95% CI, 1.24-4.98; p = 0.011) and group III (hazard ratio, 6.39; 95% CI, 2.26-18.06; p < 0.001).
  
  
  CONCLUSIONS
  Patients with elevated PASP derive less benefit from CRT. Baseline PASP could serve as an independent predictor for long-term prognosis.
authors.affiliation: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Shanghai, 200032, China.
authors.forename: Jingfeng
authors.initials: J
authors.lastname: Wang
authors.forename: Yangang
authors.initials: Y
authors.lastname: Su
authors.forename: Jin
authors.initials: J
authors.lastname: Bai
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Shengmei
authors.initials: S
authors.lastname: Qin
authors.forename: Junbo
authors.initials: J
authors.lastname: Ge
mesh_terms: D001795:Blood Pressure Determination / Q000706:statistics & numerical data*; D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: Am J Cardiol. 2008 Jan 15;101(2):238-41
references.pmid: 18178413
references.citation: Am J Cardiol. 2005 Jun 15;95(12):1436-40
references.pmid: 15950566
references.citation: N Engl J Med. 2005 Apr 14;352(15):1539-49
references.pmid: 15753115
references.citation: Pacing Clin Electrophysiol. 2007 May;30(5):603-7
references.pmid: 17461868
references.citation: Am J Physiol Heart Circ Physiol. 2005 Dec;289(6):H2450-5
references.pmid: 16055521
references.citation: J Am Coll Cardiol. 2001 Jan;37(1):183-8
references.pmid: 11153735
references.citation: J Thorac Dis. 2010 Jun;2(2):71-5
references.pmid: 22263022
references.citation: J Am Coll Cardiol. 1985 Aug;6(2):359-65
references.pmid: 4019921
references.citation: Am J Cardiol. 2006 Jan 15;97(2):260-3
references.pmid: 16442375
references.citation: J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8
references.pmid: 20620859
references.citation: N Engl J Med. 2004 May 20;350(21):2140-50
references.pmid: 15152059