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Updated: Dec 10, 2025
Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS
Published on: November 26, 2018
Correlation between cardiac resynchronization response and pulmonary artery hemodynamic parameters
Jiangjin Li1,2, Zhiyong Qian3, Henghao Qiu3
1Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029. ljh197202@sina.com.
Insights
Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients. Achieving left ventricular reverse remodeling (LVRR) and clinical response with CRT indicates a good prognosis, while clinical response alone offers a better outlook than no response.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Chronic heart failure (CHF) patients often exhibit impaired cardiac function and pulmonary hypertension.
- Cardiac resynchronization therapy (CRT) is a treatment option for select CHF patients.
- Evaluating CRT response and its impact on pulmonary hemodynamics is crucial for prognosis.
Purpose of the Study:
- To assess the response to CRT in heart failure patients.
- To investigate the correlation between CRT response and pulmonary artery hemodynamic parameters.
- To analyze the prognostic implications of CRT response in relation to remodeling and clinical outcomes.
Main Methods:
- Patients with CHF indicated for CRT were enrolled, with assessments before and 6 months after implantation.
- Echocardiography measured left ventricular end-systolic volume (LVESV) for left ventricular reverse remodeling (LVRR).
- Right heart catheterization measured mean pulmonary artery pressure (mPAP), pulmonary artery systolic pressure (PASP), and pulmonary vascular resistance (PVR).
- Patients were grouped based on LVRR and clinical response (NYHA classification improvement).
- Kaplan-Meier survival analysis assessed mortality and composite endpoint events.
Main Results:
- Of 45 patients, 68.89% achieved both LVRR and clinical response (Group A), 17.78% had clinical response without LVRR (Group B), and 13.33% had neither (Group C).
- Group A showed significant improvements in cardiac function, echocardiographic, and pulmonary hemodynamic parameters post-CRT (P<0.05).
- Group B demonstrated significant improvements in NYHA classification and pulmonary hemodynamics, but not echocardiographic parameters.
- Group C showed no significant changes in any measured parameters.
- Groups A and B had significantly lower all-cause mortality and composite endpoint events compared to Group C (P=0.005 and P=0.001, respectively).
Conclusions:
- Patients achieving both LVRR and clinical response after CRT exhibit a favorable prognosis.
- Clinical response alone, without LVRR, is associated with a better prognosis than no response, potentially linked to improved pulmonary hemodynamics.
- CRT response, particularly LVRR, is a significant predictor of long-term outcomes in heart failure patients.
Objectives:
To evaluate the response to cardiac resynchronization therapy (CRT) and the correlation between CRT and pulmonary artery hemodynamic parameters.
Methods:
The patients with chronic heart failure indicator for CRT were enrolled. The left ventricular end-systolic volume (LVESV) was measured by echocardiography and New York Heart Association (NYHA) classification was evaluated between one week before and six months after CRT. Mean pulmonary artery pressure (mPAP), pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were measured by right heart catheterization. Left ventricular reverse remodeling (LVRR) is defined as a decrease of 15% or more in LVESV at the 6th month after CRT; Clinical response is defined as a decrease of NYHA classification at or above grade 1 at the 6th month after CRT. Pulmonary hypertension (PH) was defined as mPAP≥25 mmHg. According to the response, patients were divided into 3 groups: group A (LVRR+clinical response), group B (no LVRR+clinical response) and group C (no LVRR+no clinical response). The changes of NYHA classification, echocardiographic and pulmonary hemodynamic parameters were observed in the 3 groups. The Kaplan-Meier survival curve was used to analyze the differences in all-cause mortality, combined end-point events of death or re-hospitalization due to heart failure among different groups.
Results:
A total of 45 patients with CRT implantation [aged (63.27±9.55) years, 36 males] were included. The average follow-up period was (33.76±11.50) months. Thirty-one patients (68.89%) were in group A, 9 of whom with PH. Eight patients (17.78%) were in group B, 7 of whom with PH. Six patients were in group C, all with PH. Cardiac function including NYHA classification, echocardiographic and pulmonary hemodynamic parameters had been significantly improved in group A after CRT implantation (P<0.05). In group B, NYHA classification and pulmonary hemodynamic parameters were decreased significantly (P<0.05), but echocardiographic parameters did not change obviously (P>0.05). There were no significant changes in NYHA classification, echocardiographic and pulmonary hemodynamic parameters in group C (P>0.05). Compared with group C, group A and group B had lower all-cause mortality (P=0.005) and lower incidence of composite endpoint events (P=0.001).
Conclusions:
Patients with LVRR and clinical response after CRT have a good prognosis. Patients with clinical response but without LVRR have a better prognosis than those without clinical response and LVRR, which may be related to the decrease of pulmonary hemodynamic parameters such as mPAP and TPG.
