Elevated pulmonary artery pressure predicts poor outcome after cardiac resynchronization therapy

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.

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.

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).

Patients with elevated PASP derive less benefit from CRT. Baseline PASP could serve as an independent predictor for long-term prognosis.