title: Pre-capillary pulmonary hypertension and right ventricular dilation predict clinical outcome in cardiac resynchronization therapy.
abstract: OBJECTIVE
  This study examined the prognostic significance of pre- and post-capillary components of pulmonary hypertension (PH) in patients receiving cardiac resynchronization therapy (CRT).
  
  
  BACKGROUND
  PH is common in patients with left ventricular systolic dysfunction (LVSD) receiving CRT. The impact of PH subtype on clinical outcome in CRT is unknown.
  
  
  METHODS
  The study population consisted of 101 patients (average age 66 ± 13 years, left ventricular ejection fraction 0.23 ± 0.07, and New York Heart Association functional class 3.2 ± 0.4) who underwent right heart catheterization in the 6 months before CRT. PH was defined as a mean pulmonary artery pressure ≥25 mm Hg; a significant pre-capillary contribution to elevated mean pulmonary artery pressure was defined as a transpulmonary gradient (TPG) ≥12 mm Hg. Clinical endpoints were assessed at 2 years and included all-cause mortality and a composite of death, left ventricular assist device, or cardiac transplantation.
  
  
  RESULTS
  Patients with TPG ≥12 mm Hg were more likely to experience all-cause mortality (hazard ratio [HR]: 3.2; 95% confidence interval [CI]: 1.3 to 7.4; p = 0.009) and the composite outcome (HR: 3.0; 95% CI: 1.4 to 6.3; p = 0.004) compared with patients with TPG <12 mm Hg. After multivariate adjustment for hemodynamic, clinical, and echocardiographic variables, only TPG ≥12 mm Hg and baseline right ventricular (RV) dilation (RV end-diastolic dimension >42 mm) were associated with the composite clinical outcome (p = 0.05 and p = 0.04, respectively).
  
  
  CONCLUSIONS
  High TPG PH and RV dilation are independent predictors of adverse outcomes in patients with LVSD who are receiving CRT. RV pulmonary vascular dysfunction may be a therapeutic target in select patients receiving CRT.
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Neal A
authors: NA
authors: Chatterjee
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Gaurav A
authors: GA
authors: Upadhyay
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Gaurav
authors: G
authors: Singal
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Kimberly A
authors: KA
authors: Parks
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: G William
authors: GW
authors: Dec
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Jagmeet P
authors: JP
authors: Singh
authors: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Pulmonary and Critical Care Unit of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: glewis@partners.org.
authors: Gregory D
authors: GD
authors: Lewis
mesh_terms: D000368:Aged; D002196:Capillaries; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D058406:Cardiac Resynchronization Therapy; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D017380:Hypertrophy, Right Ventricular / Q000150:complications*; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*
keywords: cardiac resynchronization therapy; pulmonary hypertension; right ventricle