Association Between Pulmonary Capillary Wedge Pressure And Clinical Outcome Of Cardiac Resynchronization Therapy In Patients With Chronic Heart Failure

BACKGROUND:Heart failure (HF) could be caused by various kinds of heart disease. It is reported that about 23,000,000 patients suffered from heart failure. The prevalence of heart failure in China is 0.9% in 35-75 year-old adults, about 0.7% in men and 1.0% in women. The heart failure therapy includes medication, equipment and heart transplantation. Cardiac resynchronization therapy (CRT) has being used for chronic heart failure these 20 years. Many randomized clinical trials have proved that CRT is associated with relieved heart failure symptoms, reduced heart volume, augmented left ventricular ejection fraction, improved New York Heart Association (NYHA) functional classes, improved 6-minte walk test distance(6MWT), reduced hospitalization rates and reduced mortality in HF patients. However, there was still about one-third patients without significant benefits from CRT. The pulmonary capillary wedge pressure (PCWP) increased in chronic heart failure patients. It had been proved that the decreased PCWP is a predictor of heart failure prognosis. Currently, there are many factors effecting CRT response such as etiology, QRS duration and morphology, left atrial volume index,amino-terminal pro-brain natriuretic peptide (NT-ProBNP) and so on. However, there were limited studies about the association of PCWP with CRT response in HF patients.OBJECTIVES:To investigate the association between pulmonary capillary wedge pressure and clinical outcome of cardiac resynchronization therapy in patients with chronic heart failure.METHODS:Thirty seven patients with chronic heart failure were included. The right heart catheterization was performed to measure PCWP in each patient before CRT implantation. Patients were divided into two groups based on their response to CRT: responders and non-responders. Receiver operating characteristic (ROC) curve was used to assess the efficiency of preoperative PCWP in predicting CRT response. Multivariate Logistic analysis was applied to find the independent factors associated with CRT response. Kaplan-Meier survival curve was applied to assess the efficiency of preoperative PCWP in predicting major adverse cardiac events (MACE).RESULTS:Thirty seven patients were included. Of 37 patients,27 were male, mean age were 64 ±9 years. Twenty-six patients were CRT responders,11 patients were nonresponders. The mean PCWP was 11.±7.0 mmHg and 21.7±9.1 mmHg in CRT responders and nonresponders, respectively (P＜0.01). By the optimal cutoff point of 12.0 mmHg, the sensitivity and specificity of preoperative PCWP predicting response to CRT were 90.9% and 57.7%, respectively. Multivariate Logistic analysis showed that baseline serum sodium and PCWP are the independent factors associating with CRT response. Kaplan Meier survival curve demonstrated that patients with preoperative PCWP 12.0 mmHg or more had lower incidence of major adverse cardiac events (MACE) compared with patients with preoperative PCWP 12.0mmHg or less.CONCLUSIONS:Preoperative PCWP and serum sodium is associated with response to CRT. Lower preoperative PCWP can predict better CRT response and MACE-free survival in CHF patients.