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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Baseline left ventricular dP/dtmax rather than the acute improvement in dP/dtmax predicts clinical outcome in
Margot D Bogaard1, Patrick Houthuizen, Frank A Bracke
1Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. M.D.Bogaard-2@umcutrecht.nl
Insights
Left ventricular dP/dt(max) measured before and during cardiac resynchronization therapy (CRT) predicts 1-year survival. However, the acute improvement in this measure does not correlate with long-term clinical outcomes.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
- Left ventricular pressure (LVP) and its rate of change (dP/dt) are important hemodynamic parameters.
- Left ventricular dP/dt(max) has been used to assess acute CRT effects.
Purpose of the Study:
- To evaluate if left ventricular dP/dt(max) measured at baseline and during CRT predicts long-term clinical outcomes.
- To determine the correlation between acute changes in LV dP/dt(max) and long-term clinical outcomes.
Main Methods:
- Retrospective observational multicenter study.
- Involved 285 patients undergoing CRT implantation.
- Invasive measurement of LV dP/dt(max) at baseline and during CRT, with a minimum 1-year follow-up.
Main Results:
- Patients experiencing the composite endpoint (all-cause mortality, heart transplantation, or LV assist device implantation) had lower LV dP/dt(max) at baseline and during CRT.
- LV dP/dt(max) levels at baseline and during CRT independently predicted 1-year clinical outcome.
- The acute increase in LV dP/dt(max) following CRT implantation was not significantly different between patients with and without adverse events.
Conclusions:
- LV dP/dt(max) measured at baseline and during CRT are significant predictors of 1-year survival free from major adverse events.
- The acute hemodynamic improvement in LV dP/dt(max) after CRT does not correlate with long-term clinical outcomes.
Aims:
The maximum rate of left ventricular (LV) pressure rise (dP/dt(max)) has been used to assess the acute haemodynamic effect of cardiac resynchronization therapy (CRT). We tested the hypothesis that LV dP/dt(max) predicts long-term clinical outcome after initiation of CRT.
Methods And Results:
This was a retrospective observational multicentre study in 285 patients in whom dP/dt(max) was measured invasively following implantation of a CRT device. The minimum required follow-up was 1 year. We analysed the relationship between dP/dt(max) and time to the composite endpoint, consisting of all-cause mortality, heart transplantation (HTX), or LV assist device (LVAD) implantation within the first year of CRT. Thirty-four events occurred after a mean follow-up of 160 days (range 21-359). Patients with an event had lower dP/dt(max) than patients without an event both at baseline (705 ± 194 vs. 800 ± 222 mmHg/s, P= 0.018) and during CRT (894 ± 224 vs. 985 ± 244 mmHg/s, P= 0.033), but the acute increase in dP/dt(max) was similar in patients with and without an event (190 ± 133 vs. 185 ± 115 mmHg/s, P= n.s.). Left ventricular dP/dt(max)-level at baseline and during CRT both predicted the clinical outcome after adjustment for gender, aetiology and New York Heart Association class: hazard ratio (HR) 0.791 [95% confidence interval (CI) 0.658-0.950, P= 0.012] and HR 0.846 (95% CI 0.723-0.991, P= 0.038), respectively.
Conclusion:
Left ventricular dP/dt(max) measured at baseline and during CRT are predictors of 1-year survival free from all-cause mortality, HTX, or LVAD implantation, but the acute improvement in dP/dt(max) is not correlated to clinical outcome.
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