Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy

Zhinian GUO; Jie YANG; Chuan LIU; Xiaoyan LIU; Xiaofeng CHENG; Yunlong CHEN; Yong ZHANG; Xiangui WENG; Rong WANG; Jiang WANG

doi:10.16016/j.1000-5404.201808140

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Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy

Clinical Medicine | 更新时间：2026-01-09

- Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy
- Journal of Third Military Medical University Vol. 41, Issue 2, Pages: 130-136(2019)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科, 全军心血管病研究所
- 作者简介：
- 基金信息：
  
  the Clinical Research Fund of Xinqiao Hospital of Third Military Medical University(2014YLC12);the Starting Fund for Talents Returning from Overseas of Ministry of Education(2015A497)
- DOI：10.16016/j.1000-5404.201808140
  CLC： R331.36;R540.4;R541.7
- Received：21 August 2018，
  
  Revised：2018-11-18，
  
  Published：30 January 2019
- 稿件说明：
移动端阅览
Zhinian GUO, Jie YANG, Chuan LIU, et al. Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy[J]. Journal of Third Military Medical University, 2019, 41(2): 130-136.
DOI：

Zhinian GUO, Jie YANG, Chuan LIU, et al. Effect of pulmonary artery systolic pressure on super-response and prognosis in patients after cardiac resynchronization therapy[J]. Journal of Third Military Medical University, 2019, 41(2): 130-136. DOI： 10.16016/j.1000-5404.201808140.

摘要

目的

评估术前肺动脉收缩压(pulmonary artery systolic pressure，PASP)对心脏再同步化治疗(cardiac resynchronization therapy，CRT)患者术后心功能、左心室重构和预后的影响。

方法

回顾性分析2014年6月至2017年12月在本院进行CRT的73例患者资料，根据超声心动图估测的术前PASP分成两组：肺动脉高压组(PASP≥50 mmHg)27例和非肺动脉高压组(PASP < 50 mmHg)46例。CRT术后6个月评估心功能，复查心电图和超声心动图，并比较两组之间的差异，采用ROC曲线评估术前PASP对CRT超反应的预测价值，采用Kaplan-Meier法进行生存分析，采用Cox回归模型分析影响长期预后的危险因素。

结果

73例患者中男性52例，女性21例，年龄(60.32±9.78)岁。CRT术后肺动脉高压组纽约心脏协会(New York Heart Association

NYHA)心功能分级、左室射血分数(left ventricular ejection fraction，LVEF)和左心室舒张末期内径(left ventricular end-diastolic dimension，LVEDD)改善程度较非肺动脉高压组差(

0.05)，肺动脉高压组LVEDD较术前无改善(

0.05)。术前PASP≤35 mmHg对CRT超反应有一定的预测价值(AUC：0.709，95%

：0.575~0.843，

0.05)。肺动脉高压组复合终点事件(心衰再入院或全因死亡)发生率高于非肺动脉高压组(

0.05)，肺动脉高压(

：3.64，95%

：1.25~10.61，

0.05)、左心房内径(left atrial dimension，LAD) (

：1.10，95%

：1.01~1.20，

0.05)是影响CRT术后患者预后的独立危险因素。

结论

术前PASP升高的患者CRT术后心功能改善、左室重构逆转的效果和临床预后较术前PASP正常的患者差，术前PASP≤35 mmHg对CRT超反应有预测价值，肺动脉高压、LAD是CRT术后患者临床预后的独立危险因素。

Abstract

Objective

To evaluate the impact of baseline pulmonary artery systolic pressure (PASP) on cardiac function

left ventricle reverse remodeling and clinical outcomes in patients receiving cardiac resynchronization therapy (CRT).

Methods

A total of 73 patients undergoing CRT in our hospital between June

2014 and December

2017 were enrolled in this retrospective analysis. According to baseline PASP estimated by echocardiography

the patients were divided into pulmonary artery hypertension (PAH) group (PASP≥ 50 mmHg;

=27) and non-pulmonary artery hypertension (NPAH) group (PASP

50 mmHg;

=46) for comparison of cardiac function

electrocardiogram and echocardiogram at 6 months after CRT. A receiver operator characteristic (ROC) curve was used to evaluate the value of baseline PASP in predicting super-response to CRT. The combined endpoints including all-cause mortality and rehospitalization for heart failure were compared between the 2 groups using Kaplan-Meier analysis. Cox regression models were constructed to analyze the risk factors for long-term prognosis of the patients.

Results

The 73 patients enrolled included 52 male and 21 female patients at a mean age of 60.32±9.78 years. At 6 months after the operation

the patients in PAH group had significantly poorer improvements in cardiac functions

left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) than those in NPAH group (

0.05)

and showed no obvious improvement in LVEDD (

0.05). ROC curve analysis showed that PASP ≤35 mmHg was capable of predicting super-response to CRT with an area under the ROC curve of 0.709 (95%

: 0.575-0.843

0.05). The patients in PAH group had a higher incidence of combined

endpoints than those in NPAH group. PAH (

=3.64

95%

: 1.25-10.61

0.05) and left atrial diameter (

=1.10

95%

: 1.01-1.20

0.05) were independent predictors for the clinical outcomes of the patients.

Conclusion

Patients with elevated baseline PASP have poorer improvements in cardiac function

left ventricle reverse remodeling and prognosis following CRT than those with normal PASP. A baseline PASP ≤35 mmHg is predictive of super-response to CRT

and PAH and left atrial diameter are independent predictors of the clinical outcomes following CRT.

关键词

Keywords

references

CLELAND J G, DAUBERT J C, ERDMANN E, et al . The effect of cardiac resynchronization on morbidity and mortality in heart failure[J ] . N Engl J Med, 2005, 352(15): 1539-1549. DOI: 10.1056/NEJMoa050496.

BRISTOW M R, SAXON L A, BOEHMER J, et al . Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure[J ] . N Engl J Med, 2004, 350(21): 2140-2150. DOI: 10.1056/NEJMoa032423.

ABRAHAM W T, FISHER W G, SMITH A L, et al . Cardiac resynchronization in chronic heart failure[J ] . N Engl J Med, 2002, 346(24): 1845-1853. DOI: 10.1056/NEJMoa013168.

ELLENBOGEN K A, HUIZAR J F. Foreseeing super-response to cardiac resynchronization therapy: a perspective for clinicians[J]. J Am Coll Cardiol, 2012, 59(25): 2374-2377. DOI: 10.1016/j.jacc.2011.11.074.

GOLDENBERG I, MOSS A J, HALL W J, et al . Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT)[J ] . Circulation, 2011, 124(14): 1527-1536. DOI: 10.1161/CIRCULATIONAHA.110.014324.

KILLU A M, GRUPPER A, FRIEDMAN P A, et al . Predictors and outcomes of "super-response" to cardiac resynchronization therapy[J ] . J Card Fail, 2014, 20(6): 379-386. DOI: 10.1016/j.cardfail.2014.03.001.

GUAZZI M, BORLAUG B A. Pulmonary hypertension due to left heart disease[J]. Circulation, 2012, 126(8): 975-990. DOI: 10.1161/CIRCULATIONAHA.111.085761.

SZWEJKOWSKI B R, ELDER D H J, SHEARER F, et al . Pulmonary hypertension predicts all-cause mortality in patients with heart failure: a retrospective cohort study[J ] . Eur J Heart Fail, 2012, 14(2): 162-167. DOI: 10.1093/eurjhf/hfr159.

PONIKOWSKI P, VOORS A A, ANKER S D, et al . 2016 ESC g uidelines for the diagnosis and treatment of acute and chronic heart failure[J ] . Rev Esp Cardiol (Engl Ed), 2016, 69(12): 1167. DOI: 10.1016/j.rec.2016.11.005.

CURRIE P J, SEWARD J B, CHAN K L, et al . Continuous wave doppler determination of right ventricular pressure: a simultaneous doppler-catheterization study in 127 patients[J ] . J Am Coll Cardiol, 1985, 6(4): 750-756. DOI: 10.1016/s0735-1097(85)80477-0.

SHALABY A, VOIGT A, EL-SAED A, et al . Usefulness of pulmonary artery pressure by echocardiography to predict outcome in patients receiving cardiac resynchronization therapy heart failure[J ] . Am J Cardiol, 2008, 101(2): 238-241. DOI: 10.1016/j.amjcard.2007.07.064.

GASPARINI M, REGOLI F, CERIOTTI C, et al . Remission of left ventricular systolic dysfunction and of heart failure symptoms after cardiac resynchronization therapy: temporal pattern and clinical predictors[J ] . Am Heart J, 2008, 155(3): 507-514. DOI: 10.1016/j.ahj.2007.10.028.

HOLZMEISTER J, LECLERCQ C. Implantable cardioverter defibrillators and cardiac resynchronisation therapy[J]. Lancet, 2011, 378(9792): 722-730. DOI: 10.1016/S0140- 6736(11)61228-2.

GALIÈ N, HUMBERT M, VACHIERY J L, et al . 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (ESC) and the european respiratory society (ERS): endorsed by: association for european paediatric and congenital cardiology (AEPC), International society for heart and lung transplantation (ISHLT)[J ] . Eur Respir J, 2015, 46(4): 903-975. DOI: 10.1183/13993003. 01032-2015.

WANG J, SU Y, BAI J, et al . Elevated pulmonary artery pressure predicts poor outcome after cardiac resynchronization therapy[J ] . J Interv Card Electrophysiol, 2014, 40(2): 171-178. DOI: 10.1007/s10840-014-9890-2.

STERN J, HEIST E K, MURRAY L, et al . Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy[J ] . Pacing Clin Electrophysiol, 2007, 30(5): 603-607. DOI: 10.1111/j.1540-8159.2007. 00719.x.

CHATTERJEE N A, UPADHYAY G A, SINGAL G, et al . Pre-capillary pulmonary hypertension and right ventricular dilation predict clinical outcome in cardiac resynchronization therapy[J ] . JACC Heart Fail, 2014, 2(3): 230-237. DOI: 10.1016/j.jchf.2014.02.004.

汪菁峰, 秦胜梅, 宿燕岗, 等.肺动脉压力与心脏再同步化治疗疗效的相关性研究[J].中国心脏起搏与心电生理杂志, 2013, 27(6): 507-510. DOI: 10.7695 /zgxzqb201306010.

WANG J F, QIN S M, SU Y G, et al . Associations between pulmonary artery systolic pressure and clinical outcome of cardiac resynchronization therapy[J ] . Chin J Cardiac Pacing Electrophysiol, 2013, 27(6): 507-510. DOI: 10.7695 /zgxzqb201306010.

WANG D, HAN Y, ZANG H, et al . Prognostic effects of pulmonary hypertension in patients undergoing cardiac resynchronization therapy[J ] . J Thorac Dis, 2010, 2(2): 71-75. DOI: 10.1136/hrt.2010.208967.553.

刘丹, 吴冬燕, 许静.心脏再同步化治疗超反应患者临床特征分析[J].临床心血管病杂志, 2016, 32(11): 1087-1091. DOI: 10.13201/j.issn.1001-1439.2016.11.005.

LIU D, WU D Y, XU J. Research of clinical characteristics of super-responders to cardiac resynchronization therapy[J]. J Clin Cardiol, 2016, 32(11): 1087-1091. DOI: 10.13201/j.issn.1001-1439.2016.11.005.

REANT P, ZAROUI A, DONAL E, et al . Identification and characterization of super-responders after cardiac resynchronization therapy[J ] . Am J Cardiol, 2010, 105(9): 1327-1335. DOI: 10.1016/j.amjcard.2009.12.058.

STEFAN L, SEDLÁ ČEK K, ČERNÁ D, et al . Small left atrium and mild mitral regurgitation predict super-response to cardiac resynchronization therapy[J ] . Europace, 2012, 14(11): 1608-1614. DOI: 10.1093/europace/eus075.

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