Can Right Heart Catheterization Improve the Prediction of Positive Response to Resynchronization Therapy?
Karolina Barańska-Pawełczak1, Wojciech Jacheć2, Andrzej Tomasik2
1Department of Cardiology, Specialistic Hospital in Zabrze, 41-800 Zabrze, Poland.
Insights
Pulmonary hypertension impacts cardiac resynchronization therapy (CRT) effectiveness in heart failure (HF) patients. Higher baseline transpulmonary gradient and pulmonary vascular resistance predict a poorer response to CRT.
Area of Science:
- Cardiology
- Heart Failure Management
- Pulmonary Hypertension
Background:
- Cardiac resynchronization therapy (CRT) is an intervention for heart failure (HF), with implantation criteria including ejection fraction, NYHA class, QRS duration, and ECG morphology.
- Pulmonary hypertension (PH) affects HF prognosis but its role in CRT response is unclear.
Purpose of the Study:
- To evaluate the prognostic significance of baseline right heart catheterization parameters for CRT response in non-ischemic HF patients.
Main Methods:
- Retrospective analysis of 39 non-ischemic HF patients undergoing CRT.
- Collected clinical, biochemical, echocardiographic, ECG, and hemodynamic data pre-CRT and 6-month post-CRT.
- Assessed CRT response criteria and baseline parameter correlations.
Main Results:
- Significant improvements observed in HF symptoms, 6-minute walk test, NT-proBNP levels, and LV function post-CRT.
- Elevated baseline transpulmonary gradient and pulmonary vascular resistance were associated with a negative impact on CRT response.
Conclusions:
- Initial assessment of pulmonary hemodynamics is crucial for predicting CRT response in non-ischemic cardiomyopathy.
- Right heart catheterization parameters offer prognostic value for CRT outcomes.
Abstract:
Background/Objectives: Cardiac resynchronization therapy (CRT) is one of the interventional methods of heart failure (HF) treatment, with the criteria for CRT device implantation based on the value of the left ventricular ejection fraction, New York Heart Association functional class, QRS complex duration, and electrocardiographic morphology. Pulmonary hypertension is an important factor influencing the prognosis of patients with HF, but its influence on CRT is not fully understood. Aim: The main aim of the study was to determine the prognostic value of baseline right heart catheterization-derived parameters on the response to CRT. Methods: It was a single-centre study with retrospective analysis of data of 39 non-ischemic HF patients. Clinical, biochemical, echocardiographic, electrocardiographic, and hemodynamic data were obtained before the CRT device implantation, and after 6 months of follow-up, non-invasive re-assessment was performed. Various criteria for the response to CRT were assessed along with the correlation between the baseline parameters. Results: After follow-up, a significant difference was found in the reduction in symptoms associated with HF, an increase achieved in the six-minute walk test distance, and a reduction in N-terminal pro-brain natriuretic peptide concentration as well as improvement of LV function assessed in echocardiographic examination. Among all parameters assessed, the baseline higher value of the transpulmonary gradient and pulmonary vascular resistance most often had a significant negative impact on meeting the criteria of response to CRT. Conclusions: The results of the analyses show that the initial assessment of pulmonary hemodynamics may be crucial in predicting the response to CRT in patients with non-ischemic cardiomyopathy.
