Abstract 16675: Invasive Hemodynamic Measurements Predict 1-Year Survival After Cardiac Resynchronization Therapy
Introduction: The acute hemodynamic response to Cardiac Resynchronization Therapy (CRT) can be assessed by the maximum rate of left ventricular (LV) pressure rise (dP/dtmax). The correlation between acute dP/dtmax and long-term outcome is yet unknown.
Hypothesis: We assessed the hypothesis that acute dP/dtmax predicts long-term prognosis after CRT implantation.
Methods: In 286 patients from 2 centers dP/dtmax was measured invasively to optimize atrioventricular and interventricular delays during CRT implantation. Four indices were evaluated: baseline dP/dtmax before CRT, maximal dP/dtmax during optimized CRT, and absolute and relative increase in dP/dtmax achieved by CRT. The composite endpoint consisted of all-cause mortality, heart transplantation (HTX) and LV assist device (LVAD) implantation within a year after implantation. Multivariate Cox regression models included a dP/dtmax variable, etiology, QRS ≥/< 150 ms and gender. Mean ± SD, hazard ratio (HR) and 95% confidence intervals are presented.
Results: Thirty-four events occurred after a mean follow-up of 160 days (range 21–359). Patients with event had lower baseline dP/dtmax (705±194 vs 801±222 mmHg/s, p=0.017) and lower maximal dP/dtmax (894±224 vs 986±244 mmHg/s, p=0.039). After adjustment, baseline and maximal dP/dtmax predicted the endpoint (HR 0.977 [0.960–0.995, p=0.014] and HR 0.982 [0.967–0.998, p=0.027] per 10 mmHg/s increase, respectively). Increase in dP/dtmax achieved by CRT did not significantly predict outcome. Patients with dP/dtmax above the median value of baseline (757 mmHg/s) or maximal dP/dtmax (964 mmHg/s) had better cumulative survival (both: Log-rank p=0.028; Figure). Corresponding hazard ratio's were 0.438 (0.212–0.906, p=0.026) and 0.421 (0.204–0.869, p=0.019), respectively.
Conclusions: LV dP/dtmax before and during optimized CRT independently predict 1-year survival after CRT implantation free from all-cause mortality, HTX or LVAD implantation.
- © 2010 by American Heart Association, Inc.