Abstract 16956: Mixed Pulmonary Hypertension Associated with Increased All-Cause Mortality in CRT
Introduction: While pulmonary hypertension (PH) has been associated with worse outcome in patients undergoing cardiac resynchronization therapy (CRT), the prognostic significance of pre- and post-capillary components of PH is unknown.
Methods: 113 patients who underwent right heart catheterization (RHC) in the 6 months prior to CRT were studied (baseline characteristics. Table). PH was defined as a mean pulmonary artery pressure (mPAP) ≥25mmHg. A significant pre-capillary contribution to elevated mPAP was defined as a transpulmonary gradient (TPG) ≥12 mmHg [TPG = mPAP-pulmonary capillary wedge pressure (PCWP)]. Time to composite endpoint (death, transplant, or left ventricular assist device) was assessed at 2 year follow-up. Multivariate adjustment was for univariate predictors (p <0.1).
Results: PH was significantly associated with the composite endpoint (Figure, Panel A) even following adjustment for univariate predictors (p=0.04). Patients with PH, TPG ≥12 mmHg had a lower PCWP compared to those with absent PH and PH, TPG <12 mmHg (Table 1). PH, TPG ≥12 mmHg was associated with an increased incidence of the composite endpoint compared to both absent PH (p=0.003) as well as PH, TPG <12 mmHg (p=0.05) (Figure, Panel B).
Conclusion: PH is associated with worse clinical outcome in patients receiving CRT. Significant pre-capillary PH appears to confer increased risk in CRT patients even in the setting of lower estimated left sided filling pressures. In patients undergoing CRT, therapeutic targeting of pre-capillary PH may warrant further exploration.
- © 2012 by American Heart Association, Inc.