Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy

Joshua Stern, E. Kevin Heist, Lorne Murray, Chrisfouad Raif Alabiad, Jeffrey Chung, Michael H. Picard, Marc J. Semigran, Jeremy N. Ruskin, Jagmeet P. Singh

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV-RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV-RR after CRT. Methods: This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12-month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP ≥ 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long-term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan-Meier method. Follow up echocardiograms to assess for LV-RR were available in 51 subjects (mean duration 7.1 months). LV-RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter. Results: The study population was composed of 24 women and 44 men (age, mean ± SD; 70 ± 11 years), with a decreased left ventricular ejection fraction ([25 ± 9]%) and a wide QRS (171 ± 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP ≥ 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2-5.5), P = 0.02). Baseline ePASP was not predictive of LV-RR (P = 0.32). Conclusion: In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP ≥ 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long-term outcome.

Original languageEnglish
Pages (from-to)603-607
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume30
Issue number5
DOIs
StatePublished - May 1 2007
Externally publishedYes

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Cardiac Resynchronization Therapy
Pulmonary Artery
Blood Pressure
Ventricular Remodeling
Heart Failure
Pressure
Stroke Volume
Hospitalization

Keywords

  • Cardiac pacing
  • Cardiac resynchronization therapy
  • Heart failure
  • Pulmonary hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy. / Stern, Joshua; Heist, E. Kevin; Murray, Lorne; Alabiad, Chrisfouad Raif; Chung, Jeffrey; Picard, Michael H.; Semigran, Marc J.; Ruskin, Jeremy N.; Singh, Jagmeet P.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 30, No. 5, 01.05.2007, p. 603-607.

Research output: Contribution to journalArticle

Stern, Joshua ; Heist, E. Kevin ; Murray, Lorne ; Alabiad, Chrisfouad Raif ; Chung, Jeffrey ; Picard, Michael H. ; Semigran, Marc J. ; Ruskin, Jeremy N. ; Singh, Jagmeet P. / Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy. In: PACE - Pacing and Clinical Electrophysiology. 2007 ; Vol. 30, No. 5. pp. 603-607.
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T1 - Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy

AU - Stern, Joshua

AU - Heist, E. Kevin

AU - Murray, Lorne

AU - Alabiad, Chrisfouad Raif

AU - Chung, Jeffrey

AU - Picard, Michael H.

AU - Semigran, Marc J.

AU - Ruskin, Jeremy N.

AU - Singh, Jagmeet P.

PY - 2007/5/1

Y1 - 2007/5/1

N2 - Background: A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV-RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV-RR after CRT. Methods: This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12-month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP ≥ 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long-term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan-Meier method. Follow up echocardiograms to assess for LV-RR were available in 51 subjects (mean duration 7.1 months). LV-RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter. Results: The study population was composed of 24 women and 44 men (age, mean ± SD; 70 ± 11 years), with a decreased left ventricular ejection fraction ([25 ± 9]%) and a wide QRS (171 ± 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP ≥ 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2-5.5), P = 0.02). Baseline ePASP was not predictive of LV-RR (P = 0.32). Conclusion: In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP ≥ 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long-term outcome.

AB - Background: A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV-RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV-RR after CRT. Methods: This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12-month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP ≥ 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long-term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan-Meier method. Follow up echocardiograms to assess for LV-RR were available in 51 subjects (mean duration 7.1 months). LV-RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter. Results: The study population was composed of 24 women and 44 men (age, mean ± SD; 70 ± 11 years), with a decreased left ventricular ejection fraction ([25 ± 9]%) and a wide QRS (171 ± 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP ≥ 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2-5.5), P = 0.02). Baseline ePASP was not predictive of LV-RR (P = 0.32). Conclusion: In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP ≥ 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long-term outcome.

KW - Cardiac pacing

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Pulmonary hypertension

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