title: Comparison of low versus high (>40 mm Hg) pulse pressure to predict the benefit of cardiac resynchronization therapy for heart failure (from the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy Trial).
abstract: Low pulse pressure (PP) is associated with poor outcome in hospitalized patients with systolic heart failure (HF). However, the relation between PP and response to cardiac resynchronization therapy with defibrillator (CRT-D) is unknown. We aimed to evaluate the relation between preimplantation PP and echocardiographic response to CRT-D and subsequent clinical outcome after 1 year. The relation between preimplantation PP and echocardiographic response to CRT-D (defined as >15% reduction in left ventricular (LV) end-systolic volume at 1 year) was evaluated in 754 patients with CRT-D with left bundle branch block enrolled in Multicenter Automatic Defibrillator Cardioverter Defibrillator Implantation Trial-Cardiac Resynchronization Therapy. The association between PP at 1 year and the risk for subsequent HF or death was evaluated using multivariate Cox model. Patients with high versus low PP (>40 vs ≤40 mm Hg [lower quartile]) had a significantly greater reduction in LV end-systolic volume, LV end-diastolic volume, and LV dyssynchrony (p<0.01 for all comparisons). In multivariate analysis, the presence of high PP was associated with a 3.5-fold (p<0.001) increase in the likelihood of a positive echocardiographic response to CRT-D. Patients with high PP (>40 mm Hg, >lower quartile) 1 year after CRT-D implantation experienced a 50% reduction in the risk of subsequent HF or death (p=0.001) and 63% reduction in death only (p=0.001), compared with patients with low PP. In conclusion, high baseline PP is an independent predictor of echocardiographic response to CRT-D, and high PP after device implantation is associated with improved subsequent clinical outcome.
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York. Electronic address: saadia_sherazi@urmc.rochester.edu.
authors.forename: Saadia
authors.initials: S
authors.lastname: Sherazi
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Abrar H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: David T
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Aktas
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Cardiovascular Division, University of Rochester Medical Center, Rochester, New York; Cardiology Department, Rabin Medical Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*